CMS has decided to expand its PET coverage policy for Medicare beneficiaries with certain cancers, removing a clinical study requirement for PET scan use in these patients.
In addition to the announcement that it will cover an initial PET scan for the initial diagnosis and treatment of most types of solid tumors, the agency also reported that it expands the types of tumors covered for PET scan use in subsequent treatment strategy to include myeloma and ovarian cancer. This makes a total of 11 indications.
"Our organization supports all evidence-based medicine and believes PET scans are a proven method for ovarian cancer patients when it comes to treating women who need restaging and or monitoring for recurrence or response to treatment,” said Cara Tenenbaum, senior policy director, Ovarian Cancer National Alliance. “CMS’ decision will aid doctors and patients in having a full and accurate measure of ovarian cancer, not only assisting with more accurate treatments, but ultimately helping to save lives."
According to CMS, its recent decision represents “an important step forward in helping physicians and their patients combat this deadly disease.” Ilyse Schuman, managing director of the Medical Imaging & Technology Alliance, agreed.
“CMS’ decision to expand PET coverage for many cancer indications gives oncologists 20/20 vision when deciding on the proper treatment for their patients,” Schuman said. “CMS’ decision is a major step forward in the war on cancer.”
In making its decision, CMS looked at numerous studies that demonstrated the value in using PET in guiding and altering cancer treatment. For example, in an April 2008 study published in the Journal of Clinical Oncology, Dr. Bruce Hillner et al found that PET scanning enabled patients to avoid additional tests or procedures 77 percent of the time. Research found that for approximately three quarters of cases in which a biopsy was the initial pre-PET recommendation, the procedure was ultimately avoided as a result of PET scanning. Additionally, in 36 percent of cases, the results of a PET scan led physicians to alter their original treatment plan.