Denial of Axumin PET CT order

[bean1008]

My insurance company (Premera) today denied my doctors request for the PET scan. Even a peer to peer didn’t help. I’d think after two surgeries and a rising PSA there’d be no doubt of the need but they apparently disagree. Anyone know any tricks to get them to reverse their decision?

Thanks!

[ctarleton]

This Axumin access/reimbursement/claims page might be helpful. It has Contact info for Axumin folks who have done this many times before, as well as sample Claims Forms and other information your ordering doctor or you can use as a reference.

axumin.com/access-reimburse...

[tango65]

Axumin is approved for BCR. Medicare pays for Axumin if it is used for BCR.

fda.gov/news-events/press-a....

This page has the codes that must be used to bill the insurance.

axumin.com/sites/default/fi...

[bean1008]

Thank you both!!

[tango65 in reply to bean1008]

Best of luck!!

[j-o-h-n in reply to bean1008]

Re: YOU.

Research of your past posts (3 months ago) said your psa was .46 in Jan. 2020....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 09/05/2020 1:26 PM DST

[ImaSurvivor1 in reply to bean1008]

bean1008. Bethpage is right. Find a clinical trial for the F-18 DCFPyL (I got it at City of Hope a year ago.) or get the GA-68, both PSMAs. They're far superior (more accurate and at lower PSA) to the Axumin anyway.

[EdBar]

What is your current PSA? Perhaps it’s not high enough for an Axumin scan to be effective. I believe it needs to be 2.0 or higher for the greatest accuracy.

Ed

[j-o-h-n in reply to EdBar]

Re: bean1008.

Research of his past posts said his psa was .46 three months ago....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 09/05/2020 1:25 PM DST

[Bethpage]

bean1008, try to find a clinical trial for the F-18 DCFPyL or the GA-68, both PSMAs. They're far superior (more accurate and at lower PSA) to the Axumin anyway. Husband's BCR was not found at PSA 1.0 by Axumin, C-11 acetate or RM2, but was found at the same PSA by DCFPyL (Stanford) and C-11 choline (Mayo Rochester).

[BMRboy]

Not sure what your PSA is. I had an Axumin scan several years ago at 0.336 to try to locate my BCR. It found nothing and I went on to have SRT. PSMA scans are much better at locating BCR's at lower PSA levels, but still not a sure thing.

[Hidden]

I’m sorry to hear this brother . Go Premera! That is pure BS ..

[bean1008]

Thanks folks! My previous PSA three months prior was .63 and now 1.32. I’d had a G68 at UCSF-San Francisco 9 months ago but was told their trial has ended. Good idea to search for another...I believe UCLA is an option? Is the F18 DCFPyL better or the G68 at my current PSA? Seems Stanford has a trial.