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G68-psma and Insurace

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Posted 12/3/2018 2:18 AM (GMT 0)
Hello everyone,

Does anyone knows if the g68-psma is covered by Insurace. I have a very good plan through my wife’s company and not sure if it’s covered.

I would appreciate your experience with this

Thank you
Posted 12/3/2018 2:36 AM (GMT 0)
Ak,

I don’t believe that PSMA scans are FDA approved yet so it would not matter at this point if insurance would cover it. There are several trials out there for PSMA scans however. I had one of these a few years ago.

Thanks,
Jerry L.
Posted 12/3/2018 3:30 AM (GMT 0)
Thanks, Jerry. Do you remember where you had it? Thanks a lot
Posted 12/3/2018 4:59 AM (GMT 0)
Here are a bunch of them..You can use this site to refine your search.

https://clinicaltrials.gov/ct2/results?cond=Prostate+Cancer&term=PSMA+scan&type=&rslt=&age_v=&gndr=&intr=&titles=&outc=&spons=&lead=&id=&cntry=US&state=&city=&dist=&locn=&strd_s=&strd_e=&prcd_s=&prcd_e=&sfpd_s=&sfpd_e=&lupd_s=&lupd_e=&sort=
Posted 12/3/2018 9:24 AM (GMT 0)
Until a method is approved by the FDA, it is almost certain that no insurance plan would pay for it.

To my knowledge, the GA68 PSMA PET scan is not yet approved in the United States. It is commonly available in other countries (Germany and Australia, for example).

Because some number of practitioners see promise in the method, there are a significant number of US clinical trials gathering data by using the method. They are allowed to use unapproved methods under controlled circumstances.

Some clinical trials may provide the scan at no cost. More commonly, there is a charge of multiple thousands of dollars to be paid by the patient.
Posted 12/3/2018 1:21 PM (GMT 0)
I had my scan at NIH in Bethesda Maryland. It was completely paid for. In fact, they reimbursed me for travel. I have nothing but good words about my experience with this trial.

The trial included a sodium fluoride f18 pet/ct along with the PSMA and they did it twice ... six months apart.

On the clinical trials website, search for just “PSMA”. There might be trials that use other agents that you might be interest in...not just GA68.
Posted 12/3/2018 1:58 PM (GMT 0)
I had mine at U. of Mich as part of a clinical trial. Yet, my Med. Adv. plan (BCBSM -- PPOM) covered it.

Mel
Posted 12/3/2018 2:24 PM (GMT 0)
Best thing to do is just call the company and ask. Also look on their website. There can be significant variations between carriers so it usually isn't worthwhile just to ask what others have.
Posted 12/3/2018 8:42 PM (GMT 0)

Ak123 said...
Hello everyone,

Does anyone knows if the g68-psma is covered by Insurace. I have a very good plan through my wife’s company and not sure if it’s covered.

I would appreciate your experience with this

Thank you

I hate to write this, but G68-PSMA is almost meaningless. Let me explain:
The idea is to target PSMA which is expressed by prostate cancer cells. This is done with a ligand that recognizes (selectively binds to) PSMA. Several ligands are being tried. So one has to be specific. In turn, the ligand is attached to a radio isotope (Ga-68), so that it can be visualized by a PET scan.
Posted 12/3/2018 8:59 PM (GMT 0)
I don’t think it’s meaningless knowing where the PC is. I guess I don’t understand your point.
Posted 12/3/2018 9:43 PM (GMT 0)

Jerry L. said...
I don’t think it’s meaningless knowing where the PC is. I guess I don’t understand your point.


The point is that if one wants to talk to an insurance company about coverage one has to properly identify the agent.
Obviously, the PSMA methodology to identify cancerous loci is very promising.
Posted 12/4/2018 12:15 AM (GMT 0)
Sr Sailor,

I'm so sorry...I totally misunderstood what you were saying...got it...thanks.
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