Medicare and Amyloid PET Imaging: The Battle Over Evidence

Karen J. Maschke, Michael K. Gusmano

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)105-122
Number of pages18
JournalJournal of Aging and Social Policy
Volume29
Issue number2
DOIs
StatePublished - Mar 15 2017

All Science Journal Classification (ASJC) codes

  • Demography
  • Gerontology
  • Life-span and Life-course Studies

Keywords

  • Alzheimer’s disease
  • Medicare coverage
  • amyloid PET imaging
  • evidence-based medicine

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