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Provenge Medicare NCD Needs More Clarity To Avoid Restrictions, CMS Told

Executive Summary

Medicare’s final national coverage decision on Dendreon’s prostate cancer vaccine Provenge (sipuleucel-T) should more clearly lay out how far local Medicare claims contractors can go in ensuring patients are eligible for treatment, comments from the manufacturer, oncology care providers and physicians say.

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Medicare Provenge Decision Addresses Treatment Eligibility Criteria

The final national coverage decision confirms that Provenge will be covered for its labeled uses and that off-label use will be left to the discretion of local administrative claims contractors.

Provenge, Jevtana Covered Without PA By Nearly 50% Of Payers In Analysis

Dendreon’s Provenge (sipuleucel-T) and Sanofi-Aventis’ Jevtana (cabazitaxel) were covered by nearly 50% of commercial plans without prior authorization requirements during the first quarter of 2011, according to an analysis of payer policies for the novel prostate cancer therapies conducted by The Zitter Group.

Provenge, Jevtana Covered Without PA By Nearly 50% Of Payers In Analysis

Dendreon’s Provenge (sipuleucel-T) and Sanofi-Aventis’ Jevtana (cabazitaxel) were covered by nearly 50% of commercial plans without prior authorization requirements during the first quarter of 2011, according to an analysis of payer policies for the novel prostate cancer therapies conducted by The Zitter Group.

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