New pathways to medicare coverage for innovative PET radiopharmaceuticals: report of a medical imaging & technology alliance (MITA) workshop

J Nucl Med. 2012 Feb;53(2):336-42. doi: 10.2967/jnumed.111.098947. Epub 2011 Dec 16.

Abstract

PET and PET/CT have revolutionized the diagnosis, staging, and monitoring of treatment effect or recurrence for a wide range of cancers and shown promise for improving health outcomes for patients with cardiovascular and central nervous system diseases. However, this technology is challenged by insurance coverage policies that hinder patients' access to PET and discourage technologic innovation. Recently, the Medical Imaging & Technology Alliance (MITA), a Washington-based industry association, convened a workshop to consider new pathways for making decisions on Medicare coverage of new PET radiopharmaceuticals and imaging procedures that are currently subject to a national noncoverage decision, or "exclusionary rule." Stakeholders from the government, medical professional societies, academia, patient groups, and industry gathered to brainstorm alternatives to the national noncoverage decision and evaluate their potential to improve access and enhance innovation. Ultimately, MITA, on behalf of the PET community, expects to use the outcomes of the workshop to propose that the Centers for Medicare and Medicaid Services reconsider this current national noncoverage decision for PET and adopt a new framework for coverage.

Publication types

  • Congress

MeSH terms

  • Fluorodeoxyglucose F18 / economics
  • Humans
  • Medicaid / legislation & jurisprudence
  • Medicaid / statistics & numerical data
  • Medicare / legislation & jurisprudence
  • Medicare / statistics & numerical data*
  • Positron-Emission Tomography / economics*
  • Radiopharmaceuticals / economics*
  • United States
  • United States Food and Drug Administration / legislation & jurisprudence

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18