Medicare and Amyloid PET Imaging: The Battle Over Evidence.
We examine a recent dispute regarding the Centers for Medicare and Medicaid Services' (CMS) refusal to unconditionally pay for amyloid positron emission tomography (PET) imaging for Medicare beneficiaries being assessed for Alzheimer's disease. CMS will only pay for amyloid PET imaging when patients are enrolled in clinical trials that meet certain criteria. The dispute reflects CMS's willingness in certain circumstances to require effectiveness evidence that differs from the Food and Drug Administration's standard for pre-market approval of a medical intervention and reveals how stakeholders with differing perspectives about evidentiary standards have played a role in attempting to shape the Medicare program's coverage policies.
a Research Scholar , The Hastings Center , Garrison , New York , USA.
Karen J
KJ
Maschke
b Associate Professor of Health Policy , Rutgers University , New Brunswick , New Jersey , USA.
Michael K
MK
Gusmano
D000544:Alzheimer Disease / Q000000981:diagnostic imaging / Q000191:economics; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics; D002986:Clinical Trials as Topic; D034462:Dissent and Disputes / Q000191:economics*; D019317:Evidence-Based Medicine; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D006278:Medicare / Q000191:economics*; D049268:Positron-Emission Tomography / Q000191:economics*; D014481:United States
Alzheimer’s disease; Medicare coverage; amyloid PET imaging; evidence-based medicine