CMS Continues To Limit Coverage For NaF-18 PET Scans For Bone Metastases

There has been a lot of buzz around the new scanning contrasts that have come into limited usage for evaluating metastasized cancer cells that are in the bones. Despite the enthusiasm from the prostate and breast cancer communities, CMS (Medicare) continues to limit its financial coverage for PET scans using the contrast NaF-18 even though [...]

Xofigo Pricing To Change With Patient Costs To Be Reliant On Weight Sensitive Dosages

As of January 1, 2015 there will be some significant changes in the billing and reimbursement schedule for men receiving Bayer healthcare’s radium Ra223 dichloride (Xofigo). Xofigo is FDA approved for the treatment of men with castration-resistant metastatic prostate cancer (mCRPC) who have symptomatic bone metastases and no known visceral metastatic disease. These changes result [...]

Provenge Receives A Positive National Determination from CMS

Yesterday Dendreon, the producers of Provenge, received word from the FDA that their plant in California had been approved to manufacture Provenge. This afternoon they received a positive response from the Centers for Medicare and Medicaid Services (CMS) that a final National Coverage Decision (NCD) for Provenge has been issued requiring Medicare contractors to cover [...]

Finally, CMS Announces A Meeting to Discuss Medicare Coverage for Provenge

The Center for Medicare and Medicaid Services (CMS), the U.S. agency in charge of Medicare, announced yesterday that it has scheduled a meeting to discuss the coverage of Dendreon’s prostate cancer vaccine Provenge. The meeting has been scheduled for this November 17. […]

An Editorial – What Has Caused the Recent Review of Provenge by the CMS

There has been a lot of questions raised about why the Centers for Medicaid and Medicare Services (CMS) has out of the clear blue, launched a review of Provenge, a review that could ultimately make Provenge unavailable to men on Medicare and Medicaid (see the post:Medicare Funding for Provenge, We Urgently Need Your HELP). There [...]

Medicare Funding for Provenge, We Urgently Need Your HELP

How are funding decisions made for Medicare and Medicaid? What drugs are to be funded? These questions have recently come to our attention as many of us have attempted to have Medicare fund our use of Provenge. The administration of Medicare is actually broken into 15 different regions, or MACs (Medicare Administrative Contractors). Each MAC [...]