The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has asked Aetna to reconsider its reimbursement policy for two PET radiotracers.
In a letter to Aetna, the SNMMI raised concerns about the payor's policy of not covering exams performed with gallium-68 DOTATATE, marketed as Netspot by Advanced Accelerator Applications (AAA), and fluciclovine F-18, sold as Axumin by Blue Earth Diagnostics. On March 30, Aetna issued a coverage policy update that classified both radiotracers as experimental.
In its letter, the SNMMI maintained that Aetna's policy runs counter to approval granted to DOTATATE by the U.S. Food and Drug Administration (FDA) in June 2016, as well as guidelines from the National Comprehensive Cancer Network (NCCN) and the SNMMI's own appropriate use criteria. Aetna continues to cover indium-111 pentetreotide, an older radiopharmaceutical that is inferior to DOTATATE, according to the society.
Regarding fluciclovine, the SNMMI noted that the FDA in May 2016 approved the radiotracer in men with suspected prostate cancer recurrence based on elevated blood prostate-specific antigen (PSA) levels after prior treatment. As with DOTATATE, the NCCN has updated its guidelines to include fluciclovine imaging.
