Dr. Wy, why won’t my insurance company pay for the new blood test for Alzheimer’s Disease I heard about on TV?

Ask Dr. Wy…

Richard Wyderski, MD, FACP

Dr. Wy, why won’t my insurance company pay for the new blood test for Alzheimer’s Disease I heard about on TV?

On May 16th the Food and Drug Administration (FDA) approved the first blood test designed to diagnose Alzheimer’s Disease early, called “Lumipulse G pTau217/ß-Amyloid 1-42 Plasma Ratio.” It tests for an abnormal blood protein called “p-tau 217” and measures the ratio of two other proteins, “amyloid 42” and “amyloid 40.” This test is most useful when the person has undergone thorough clinical and neuropsychological evaluations that confirm abnormal cognition and there isn’t another reason found. If that’s the case the blood test is 90% accurate in making an Alzheimer’s Disease diagnosis, which is even better than the accuracy of a specialist only using clinical criteria.

This blood test is important because there is now treatment that may slow down Alzheimer’s Disease, the medications donanemab and lecanemab that help eliminate amyloid protein from the brain. An imaging test called an “amyloid PET scan” can confirm that there’s an abnormal amount of it, and the sooner treatment is started, the more effective it is for preserving a person’s ability to think and reason. It can have serious side effects, though, and is very expensive, so neurologists need to be very sure of an accurate diagnosis before prescribing it.

Why aren’t insurance companies covering this new test? It’s probably too soon. If it’s like most other tests, it will be reviewed by Medicare and then eventually approved. Other insurance companies usually then follow with their own approvals. Unfortunately, this whole process can take years, but FDA approval is a crucial first step.

Don’t give up hope.

Have a question for Dr. Wy? Please submit to [email protected]