I am deliberately withholding all but one, dry sentence of commentary. Otherwise, just the facts, as reported, follow. All emphasis is mine.
The U.S. Medicare and Medicaid health programs will cover the cost of infusing Dendreon Corp’s prostate cancer vaccine Provenge in addition to the drug itself, the company said on Monday. […]
The vaccine was approved to much fanfare and began selling in May 2010, but has endured a disappointing launch in part due to physician uncertainty about reimbursement for the medicine that costs about $93,000 for a course of three infusions. […]
Physicians are reimbursed $125 per infusion for administering biologic drugs, on average, depending on geographic location and the length of the infusion, said Katherine Stueland, a spokeswoman for Dendreon.
The CMS decision will cover claims for infusion costs of Provenge retroactive to June 30.
And what does Provenge, or sipuleucel-T, do? Here’s an answer from a Clinical Cancer Research drug update dated June 1, 2011 (ungated pdf):
In men who have metastatic castration-resistant prostate cancer with no or minimal symptoms, sipuleucel-T prolongs median survival by 4.1 months compared with results in those treated with placebo. At 3 years, the proportion of patients in the vaccine group who were alive was 50% higher than that in the control group (31.7% versus 21.7%, respectively). Sipuleucel-T, which is designed to elicit an immune response to prostatic acid phosphatase, uses the patient’s own immune system to recognize and combat his cancer. Currently, no other agents are available that offer a survival benefit for this population of asymptomatic patients who have not been treated with chemotherapy, except for docetaxel (whose inherent toxicities often lead patients and physicians to delay administration until symptoms develop). Straightforward strategies to increase the efficacy of sipuleucel-T are likely to provide even greater benefit.
With reimbursement of infusion claims, expect Provenge use to go up, with all commensurate consequences for health and budget. That is all.
