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Heinrich, Markey, Capito Applaud Biden Admin. for Heeding Call to Expand PET Scan Coverage for Alzheimer’s Patients

WASHINGTON – Today, U.S. Senators Martin Heinrich (D-N.M.), Edward J. Markey (D-Mass.), and Shelley Moore Capito (R-W.V.) applauded the Centers for Medicare & Medicaid Services (CMS) for heeding their call to provide more comprehensive coverage for amyloid PET scans, a critical tool in the diagnosis and treatment of patients with Alzheimer’s disease.

If finalized, this week’s announcement by CMS would mark an important step toward ensuring patients with Medicare coverage can access the best medical services available in the course of their treatment without facing prohibitory costs. Currently, people on Medicare only receive coverage for one amyloid PET scan per lifetime while participating in a clinical trial. This proposed decision would remove that cap and expand coverage, subject to the determination of Medicare Administrative Contractors.

“The only way to treat Alzheimer’s Disease is to continue expanding access to diagnostic tools, like amyloid PET scans. I’m grateful that the Biden Administration listened to our calls to expand Medicare coverage for amyloid PET scans, and I was glad to lead the charge with Senators Markey and Capito late last year to get this done,” said Heinrich. “This expanded coverage will ensure Medicare beneficiaries receive a diagnosis sooner and enable early treatment. It’s a huge step in the right direction.”

“Getting an Alzheimer’s diagnosis is hard enough. It shouldn’t also bankrupt patients,” said Markey. “Health care should be a right, not a privilege for the few who can pay thousands of dollars out of pocket to access the most advanced tools. I am grateful that the Biden administration has heard our calls and taken a critical step to expand Medicare coverage for amyloid PET scans. We must ensure that every participant in the health care system – from pharmaceutical companies to insurers – is working together to make essential tools for Alzheimer’s diagnosis and care available and accessible to all who need it.”

“Alzheimer’s disease is a devastating reality for millions of Americans and their families, and I’ve seen first-hand the harsh toll that it takes on both individuals and loved ones. This decision from CMS will modernize and strengthen the ability to accurately diagnose and treat this terrible disease as early as possible. I’m pleased that our calls we’re heeded by the administration and that this important step in our fight against Alzheimer’s disease was taken,” said Capito.

In December 2022, the three senators wrote to Secretary of Health and Human Services (HHS) Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure urging the officials reconsider a 2013 national coverage determination (NCD) that for nearly a decade limited Medicare coverage of certain brain imaging procedures critical for diagnosing Alzheimer’s disease. Specifically, the NCD restricts brain imaging for Medicare recipients to a single scan during a person’s lifetime, contingent on a patient’s enrollment in a clinical trial. New evidence suggests that ‘amyloid PET’ imaging of the brain is effective in detecting Alzheimer’s disease.