SNMMI urges Aetna to alter coverage of 2 PET tracers

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) addressed two letters to Aetna, recommending the health insurance giant alter its radiopharmaceutical coverage policy to include PET imaging agents dotatate and fluciclovine.

In the April 18 letter, Munir Ghesani, MD, and Chair Advocacy Domain at SNMMI, argued Aetna’s policies don’t "reflect recent evidence” from the FDA, along with 12 other entities which, in 2016, approved the use of gallium GA 68 dotatate PET in somatostatin receptor positive neuroendocrine tumors in appropriate patients.

In a similar letter sent the same day, Ghesani urged Aetna to reconsider its stance to include fluciclovine, citing the FDA’s approved use of the imaging agent in certain men with suspected prostate recurrence. 

Currently, Aetna’s policy describes an OctreoScan, using octreotide (Sandostatin) tagged with radiolabeled 111-Indium-penetreotide as “medically necessary,” instead of the proposed dotatate. It’s policy also considers gallium Ga 68 dotatate PET experimental and investigational.

“We know that Aetna wants to be known for allowing its beneficiaries access to state-of-the-art care, and we believe the company will modify this coverage policy in that spirit,” Ghesani wrote in the letters.