The Medical Imaging & Technology Alliance (MITA) has requested that the Centers for Medicare & Medicaid Services (CMS) reconsider its national non-coverage decision for PET tracers and remove the exclusionary language that denies coverage for new PET imaging agents.
Such a move by the CMS would allow local coverage decisions, giving regional Medicare carriers the flexibility to evaluate coverage once the FDA approves the product for medical use.
"Though PET tracers have already demonstrated medical efficacy and promise, Medicare coverage is essential to improve patient access," MITA said.
Earlier this year, the alliance convened a PET coverage workshop to consider new pathways for Medicare coverage of PET radiopharmaceuticals and imaging procedures. Stakeholders from the government, medical professional societies, academia, patient groups and industry gathered to evaluate the potential of such pathways to improve access and promote innovation, which led to the formal reconsideration request.
“The request by MITA is an important step in the process for obtaining additional coverage of PET/CT by the CMS. The National Oncologic PET Registry looks forward to working with MITA and the CMS in developing further appropriate coverage of PET/CT,” noted R. Edward Coleman, MD, and Barry A. Siegel, MD, co-chairs of the National Oncologic PET Registry Working Group.