Approved in April 2010, Dendreon Corp. s prostate cancer drug Provenge is revolutionary in that it uses the patient s own cells to stimulate the immune system to fight off the disease. Despite its projected success, however, physicians are hesitant to prescribe the treatment because they are encountering too many reimbursement obstacles a particularly strong disincentive, given its cost.
The treatment extends patient survival by about four months, yet costs $93,000 for a standard course. Medicare recently decided to cover the drug anyway a decision that is expected to make it easier and faster for physicians to be reimbursed when administering the therapeutic vaccine to Medicare patients.
ACSH s Dr. Gilbert Ross admits having mixed feelings about the treatment since it is expensive relative to the health benefits it offers. Still, he believes that if the drug has gained approval for federal insurance coverage, forcing patients and doctors to jump through a series of hoops for get reimbursement is akin to rationing. These obstacles should be lowered or removed, he says.
Considering this is the first and only specific cancer vaccine in the U.S., it s a bit disturbing that its access seems to be limited by paperwork, adds ACSH s Dr. Josh Bloom. And for doctors to be avoiding its use because of that is just wrong.
