Analysis section only, CMS removes NCD regarding amyloid PET scans. AI summary found further below.
- Advances in Medical Care and Treatments: There have been significant advances in medical care and treatments for Alzheimer's disease (AD), including lifestyle changes, risk factor management, and the development of antiamyloid drug treatments. These advancements have rendered the once-in-a-lifetime limit on amyloid PET scans outdated.
- Importance of Patient Selection: The development of antiamyloid drug treatments requires the confirmation of the presence of brain amyloid pathology, which can be achieved through amyloid PET scans. Ensuring that patients have brain amyloid is crucial to determining the benefits and avoiding potential harms of these treatments.
- Evolving Clinical Research: Clinical research is now focused on new treatments directed against amyloid, which necessitate the use of tests like amyloid PET scans to confirm brain amyloid pathology.
- Stakeholder and Patient Feedback: Stakeholders and patients have expressed concerns about the limitations on the choice of treatments and the appropriate management of antiamyloid treatments due to the once-in-a-lifetime limitation on amyloid PET scans.
- Local MAC Discretion: Allowing Medicare Administrative Contractors (MACs) to make coverage determinations for amyloid PET scans based on individual patient factors and local clinical environments is seen as more flexible and responsive to evolving medical care and treatment standards.
- Health Disparities: Recognizing health disparities in AD prevalence among racial and ethnic groups, CMS aims to address these disparities by allowing local MACs to determine coverage for amyloid PET scans for patients with Mild Cognitive Impairment (MCI) due to AD or mild AD dementia.