The battle to make sure that Provenge is available nationally (in the United States) to all men who meet the FDA approval requirements is continuing. We have made great steps through the “noise” that the community has made to date. We have successfully reached, what I believe is, the final step in insuring that Provenge will be universally available through the Medicaid and Medicare systems. When the Advisory Committee delivered their final report to the Centers for Medicaid and Medicare Services (CME) they made many mentions that the community had made their demands very clear, to approve Provenge for full reimbursement.
The Advisory Committee heard our collective voice and responded to it.
We have reached the final step in the process of insuring that Provenge be universally available. The Advisory Committee has spoken and recommended that the CME approve Provenge for universal coverage. Now, CME is considering the question and there is another public comment period as they make this important decision. It is clear to me that we, the prostate cancer community, made a difference in the decision of the Advisory Committee. Now it is our time to again make a difference in this final, vital step.
I urge that you, your family and your friends again submit a comment in support of universal coverage. Even if you have already submitted a comment to the Advisory Committee you need to again submit a comment.
You can do this by CLICKING HERE.
The following is the comment that I have submitted:
Men fighting advanced prostate cancer must have available all the tools we know that extend their life. Currently, there are only three of these tools available, one of which is Provenge.
There is no excuse that any man who falls within the population that the evidence has clearly demonstrated will experience life extension should not have Provenge available through Medicaid or Medicare.
It is clear from the Centers for Medicare and Medicaid Services (CMS) draft determination that the evidence is adequate to conclude that the use of autologous cellular immunotherapy treatment – sipuleucel-T; PROVENGE® improves health outcomes, extends life, for beneficiaries with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer, and thus is reasonable and necessary for that indication under 1862(a)(1)(A) of the Social Security Act (the Act).
I urge that Provenge be fully covered under the Social Security Act and that the rules be written to be clear that any man meeting the qualifications be provided the required coverage.
Joel T Nowak, M.A., M.S.W.
My partner is on Medicaid, and he was prescribed Provenge. Medicaid refused to pay for it. The doctor appealed, and the appeal was denied.
What can we do?
I am sending this email on to my person at Dendreon to see if he can do something to help. – Joel
I just received a response from y contact. He replied:
Make sure he’s asking his doctor (and calling On Call himself if necessary) to make sure he applies for the uninsured program, because if his primary insurance is Medicaid and he has no other insurance, if the denials continue, he’ll be considered “rendered uninsured” and could potentially qualify to be treated under our uninsured program.
Let me know what happens. – Joel
Joel, I have a question. My dad meets all of the qualifications for provenge except he takes a pain med. This is all new to me but I am confused as to how there are any qualifying candidates for this drug who have advanced prostate cancer that has moved into other locations. Is there any light you can shed on this for me? Also, you mentioned provenge is one of three drugs that extends life. Is Zytiga the other one? What are the other two? Your response would be most helpful and thanks for what you are doing to educate the community!!
Clarice – The label for Provenge says that a man must be asymptomatic or minimally symptomatic. I assume that by virtue of his needing pain killers he is ruled out. You might want to try a different doctor who might push for an approval. The currently approved drugs to treat advanced prostate cancer that have shown any survival advantage are: