Insurance Coverage of AD Diagnostics? Not Without Better Data

15 December 2012. The quest for health insurance coverage of brain amyloid scanning just took a twist. On 13 December 2012, the Centers for Medicare and Medicaid Services (CMS), the government agency that administers the Medicare program, proposed lifting a nationwide exclusion on coverage of new positron emission tomography (PET) tracers, but only for agents used in oncology. The CMS will continue to exclude coverage of other new PET ligands, including amyloid imaging agents. Most private payers follow CMS’ lead. The CMS decided to defer a decision on amyloid agents until next July….

… What factors will likely influence CMS’ ruling? The key question for insurers is whether new diagnostic tests improve patient care, according to a white paper released 12 December 2012 by The Institute for Clinical and Economic Review (ICER), an academic research group based at Massachusetts General Hospital’s Institute for Technology Assessment, Boston.