Updated eviCore Oncology Guidelines List Ga68 Dotatate as Experimental

What is the news?

eviCore, one of the leading medical benefits management companies in the U.S., has updated its coding recommendations for PET imaging in oncology. Per this decision, eviCore will not cover Ga68 DOTATATE – listing it as experimental despite the June 1, 2016 FDA approval.

Why does this matter?

eviCore processes 12 million claims annually.
This decision could deprive patients of access to FDA-approved, commercially available, and highly valuable Ga68 Dotatate PET/CT.

What is NorCal CarciNET Community doing?

NorCal CarciNET's board sent a letter to eviCore expressing our concern and asking them to reconsider their position given the medical evidence and the success our community has had with the scan. Click here for the Society of Nuclear Medicine and Molecular Imaging letter.

What’s next?

NorCal CarciNET is working with our partner the SNMMI and other NET advocacy groups to hopefully have the guideline updated to include Ga68 Dotatate. This impacts only those whose insurance use eviCore to manage benefits, this does not include Medicare.