Medicare to Cover Up to Three PET Scans for Women with Recurrent Ovarian Cancer

On June 11, 2013, the Centers for Medicare and Medicaid Services (CMS) released a memo on access to PET scans for cancer patients. The Decision Memorandum allows cancer patients who are covered by Medicare to receive up to three PET scans when those scans are used to determine treatment strategy for recurrent cancer. In March, CMS announced it was considering requiring coverage of one scan for patients whose cancer recurs. The Alliance weighed in with the agency, urging it to consider access to more PET scans when medically necessary. We are pleased that CMS has taken steps in the right direction to ensure women can access appropriate treatment.

We hope that CMS will consider some of the additional suggestions included in the Alliance’s comments:

  • Patients whose tumor does not emit the CA-125 protein should be granted a blanket approval for appropriate imaging, as it will always be medically necessary
  • Medically necessary be defined, in the case of ovarian cancer, as included but not limited to situations in which medical uncertainty exists; this definition could include some limit on how many PET scans are reasonable and safe for a survivor to receive per year
  • Administrative burdens be minimized for patients whose providers have determined that a PET scan is the appropriate tool to determine the best course of treatment
  • Outcomes data be collected and analyzed to determine whether PET scans truly help provide quality care

Women who have recurrent ovarian cancer and are on Medicare now have access to up to three PET scans to determine treatment strategy. The Alliance stands ready to work with patients, providers and CMS on ensuring that women with ovarian cancer have medically appropriate access to PET scans.