Medicare: Ensure Access to Advancements in Alzheimer’s Diagnosis, Treatment

Losing a loved one is always a difficult experience, but for friends and families of those living with Alzheimer’s the loss is particularly prolonged and difficult.

Five years ago, my mother passed away after a 10-year battle with Alzheimer’s disease. When she was diagnosed in 2008, there were no definitive diagnosis tools available to her. All too quickly, we went through the stages of the disease: memory loss, fear and hallucinations, loss of speech, nightmares, and a physical deterioration that eventually saw her bedbound and unable to swallow food and liquids. Sadly, this heartbreaking experience of watching someone I love slowly deteriorate mentally and physically is one I share with tens of millions of people around the world.

Today, dementia affects 55 million people globally, and more than seven million Americans live with Alzheimer’s, the seventh-leading cause of death in the country. Unfortunately, there is no cure and patients have had limited treatment options. However, recent advancements in therapeutics are raising the hopes of millions of Alzheimer’s patients and their families.

The Food and Drug Administration (FDA) has approved a new Alzheimer’s therapy. This drug targets and reduces amyloid plaque in the brain—one of the telltale signs of the disease. A new treatment option for those with Alzheimer’s is certainly news worth celebrating. It’s the moment we’ve all been waiting for. But access to this treatment could be severely limited if patients lack access to the proper diagnostic tools.

Confirming a diagnosis of Alzheimer’s, the most common form of dementia, while the patient is still alive is now possible thanks to advanced imaging that helps doctors confirm the presence of amyloid plaque. Since new Alzheimer’s therapies specifically target these amyloid plaques, it is imperative for patients that their doctors are making treatment decisions with the best possible images of amyloid in the brain.?

That is why diagnostic amyloid positron emission tomography (PET) scans are so crucial. For many years, these kinds of PET scans have been the gold standard to view amyloid plaque in the brain, helping doctors to more accurately confirm or rule out an Alzheimer’s diagnosis.

For Medicare beneficiaries to receive a newly FDA-approved therapeutic, they must first have confirmation of their Alzheimer’s diagnosis. However, Medicare currently only covers an amyloid PET scan if a patient is enrolled in a clinical study. Even then, Medicare only covers one PET scan for a patient’s entire lifetime – a policy that should be amended to allow for follow up scans. This will ensure physicians can determine the appropriate treatment and help evaluate whether the therapeutics are working for patients suffering from this devastating disease.

The innovations taking place in diagnostic imaging and treatment for Alzheimer’s are groundbreaking—especially since amyloid PET scans can indicate an Alzheimer’s diagnosis early in a patient’s disease progression.

Medicare must ensure patient access to amyloid PET scans by removing the one scan per lifetime limit and providing national coverage of amyloid PET scans. Doing so will enable physicians nationwide to more efficiently and effectively confirm an Alzheimer’s diagnosis so they can prescribe their patients these innovative treatments.

Alzheimer’s took my mother from me. For as long as the disease allowed it, she remained a mother, showing courage and resiliency and often begging me not to worry. But the reality is, seeing her so frightened as she deteriorated was a very traumatic journey.

I do not wish that experience on anyone, but it has driven my purpose at work where I am fully dedicated to serving healthcare providers and improving patient outcomes. These diagnostic tools and new treatment options could be a game changer for millions of Alzheimer’s patients and their families, but Medicare must update its policies on amyloid PET to ensure patient access to these new therapies.