Important Step Forward in IMF’s 2-Year Effort for PET Scan Reimbursement for Myeloma Patients
NORTH HOLLYWOOD, CA (February 1, 2005) The International Myeloma Foundation (IMF), the nation’s oldest and largest myeloma organization, applauds the Centers for Medicare & Medicaid Services (CMS) decision to expand coverage for positron emission tomography (PET) scans for Medicare beneficiaries for certain use in evaluation of patients with multiple myeloma, as well as a broad range of other cancers. The IMF has been working toward obtaining reimbursement for PET scans for myeloma patients for more than two years.
“ The IMF is extremely pleased that Medicare has expanded coverage for PET scans for myeloma patients in certain circumstances,” said Brian Durie, M.D., IMF Chairman. “We have worked hard for reimbursement because we believe PET scanning is an important tool for diagnostic evaluation, staging, and monitoring for myeloma. This is a very encouraging decision by Medicare, and an important step forward for myeloma patients.”
Dr. Durie and Dr. Alan Waxman, Chief of Nuclear Medicine at Cedars-Sinai Medical Center , submitted a request to Medicare to obtain reimbursement for whole body PET scanning in myeloma and related diseases more than 2 years ago. Medicare took this submission under advisement, but the request was not processed because of insufficient data.
Dr. Durie met with CMS officials in 2003 and 2004 to present all of the available data, including experiences from Cedars-Sinai Medical Center and the University of Arkansas for Medical Sciences. Although the data was promising, it was not sufficient to reach a normal regulatory standard. Medicare was thus encouraged to explore new mechanisms for reimbursement and/or approval.
In a demonstration of support to expand PET scan coverage, Senate Cancer Caucus leaders Senators Dianne Feinstein (D-CA) and Sam Brownback (R-KS) and 35 U.S. senators sent a letter to then-Secretary of Health and Human Services Tommy Thompson to expand Medicare coverage for PET scans to include myeloma and six other cancers to the existing reimbursement schedule on April 28, 2004. Late in 2004, agreement was reached to reimburse for PET imaging in unique ways. Multiple myeloma is included in these approved reimbursement decisions.
Reimbursement will be granted for PET scans in two ways: 1) as part of ongoing clinical trials registered in advance with Medicare, and 2) through participation in a new PET scan registry. For more information visit the Medicare (CMS) web site at www.cms.hhs.gov.