CMS has finalized its proposal of last September not to pay for PET scans using the sodium-fluoride radiopharmaceutical NaF-18, which the agency says still lacks evidence backing it as “reasonable and necessary” in the diagnosis and treatment of cancer that has metastasized to the bones.
In a Dec. 15 decision memo, CMS said that, over the next two years, it will continue reimbursing for NaF-18 PET under coverage with evidence development (CED) conditions, by which CMS reimburses for new drugs and devices while gathering further evidence on clinical efficacy.
CMS had been reviewing NaF-PET reimbursement largely in response to requests from advocates led by the National Oncologic PET Registry (NOPR), which began collecting data supporting NaF-18’s contribution to improved patient management in 2011.
CMS says it will reconsider its national coverage determination “at such time when the evidence has been published in a peer-reviewed journal.”
The decision memo is posted online.
As of press time, NOPR had not yet posted an announcement or alert.