Urge AETNA to cover Ga68 DOTATATE PET scan (NETSPOT) for Neuroendocrine tumor
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On June 1, 2016, the U.S. Food and Drug Administration (FDA) approved the NETSPOT (Gallium68 DOTATE) PET/CT scan for imaging in patients with neuroendocrine tumors (NETs), a rare type of cancer that is difficult to detect (see https://www.fda.gov/NewsEvents/Newsroom/%20PressAnnouncements/ucm504524.htm Shortly after its approval by the FDA, the Centers for Medicare and Medicaid services (CMS) followed suit with approved reimbursement beginning January 1st, 2017. There are many studies confirming its superiority to the previously used Octreotide scan. However, Aetna continues to deny coverage for NETSPOT, citing in section B.39 of their PET policy that “Aetna considers Ga68 Dotatate PET /CT(NETSPOT) experimental and investigational for neuroendocrine tumors and for all other indications.
Many studies have demonstrated the superiority of the Ga68 DOTATATE PET/CT scan over the previously used Octreotide scan. According to the studies It has higher accuracy of detection, better quality images, and most importantly, has important implications for treatment. If the scan is positive, it shows that the patient is a candidate for treatment with its theranostic twin, the recently approved Lu177 DOTATATE, which binds to the same receptors. It can also help in the identification of previously undetected primary or metastatic disease resulting in positive surgical outcomes. We believe that this will lead to better patient outcomes as patients receive appropriate treatment based on the additional information the this imaging procedure can provide.
The Ga68 Dotatate PET/CT (NETSPOT) scan is far easier diagnostic test for patients to undergo than Octreotide scan. The Octreotide scan requires patients to make multiple visits on subsequent days (3-4), requires a special diet with some patients needing to use laxitives and takes many hours per day away from work and/or family. The NETSPOT PET/CT on the other hand is just one short visit (2-3 hours). Many patients have to travel for imaging and NETSPOT allows them to get high-quality images in just one visit, accelerating the entire process and of getting results and making vital treatment decisions.
While we respectfully disagree with Aetna on their position that NETSPOT PET/CT is experimental and has not been shown to lead to meaningful treatment changes, we ask that Aetna change their policy and allow Netspot to be used for the FDA approved indication. Even if the Octreoscan and the Ga68 Pet/CT Dotatate gave similar results, the improved patient experience (a few hours, not dietary change vs 3-4 days of imaging), is a compelling reason on its own.
Join us in urging AETNA to change their policy regarding Their denial of coverage for the Ga68 DOTATATE PET?CT scan (NETSPOT). We petition AETNA to cover NETSPOT for the sake of better patient convenience, less days missed from work and what we believe are also improved patient outcome.
More information on the Ga68 DOTATATE PET scan can be found here: https://www.carcinoid.org/2017/04/06/gallium-68-petct-scanning-neuroendocrine-tumors-information-locations/
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