It's Medicare saying that it's going to determine whether or not they will consider the drug is suitable for reimbursement. Okay... great.. they often get these requests when they start to get bills sent to them from a new drug that gets approved... that's standard in the industry. Big whoop... they base their decision largely on whether or not it's and effective treatment... and duh... it is.
However, the bigger story here is that who cares about medicare right now? Folks like Aetna and other insurance companies have already done their own interal decisions and approved the payment for it.
They company can only treat 2% of the patient pool right now anyway... and they obviously will just treat the folks with coverage first.... medicare is a non issue at this point it's it's bound to be determined approved anyway...
Silly selling here...
The drug is perfectly designed to extract as much money from taxpayers as possible. As advanced prostate cancer is found mostly in men over 65 years of age, Provenge will be covered by Medicare Part B (see page 31), which reimburses the cost of any FDA infusion or injection drug, such as Provenge. Only a small minority of patients under 65 (and therefore not Medicare recipients) will use private health insurance to pay for the drug — and those insurers might, rightly, balk at the price.
"You can charge $500,000 a year and Medicare, under current policy, can’t do anything about it. They can’t."
The point here is if I'm paying for an expense drug for a huge population of users, I would like to study if the patients are really getting better or draining my reservoir.
The risk is if the study is inconclusive and I determine that I will not or limit the pay. Others will follow since I the huge payer.
The HMO coming out sayings they will cover for now because they don't want to lose clients. PR release.
You miss the point.
Certainly the vast majority of Provenge patients are covered by Medicare; some might be covered by Medicare Advantage (private company providing Medicare coverage). But I'm guessing relatively few are on private insurance. Thus, it's impossible to overstate the importance of whether Medicare will pay for this drug.
This is no obligation for Medicare to pay for every approved drug. That is the significance of their statement that they want to conduct an analysis "to determine whether or not [PROVENGE] is reasonable and necessary under sections 1862(a)(1)(A) and/or 1862(a)(1)(E) of the Social Security Act."
If they deem it is not reasonable, then private insurers will follow suit. Why would they pay for Provenge if they can weasel out if doing so based on Medicare's analysis? You think an insurance company cares about their beneficiaries more then their ability to limit payments?
Sure, the analysis might take a long time, many months or years. But this is now a huge black cloud over Provenge. The questioning will be incessant: Is it really safe? What will the analysis show? Is facility completion the only limiting factor? Will men risk stroke? Etc.
This news will limit the promise of DNDN for months or years.
One can only hope the hysteria holds and the opportunity to buy at $25 still exists at the open tomorrow.
They are trying everything they can to knock to share price down. Last week it was ..there are no orders. This week, Medicare crap.
All static. All of it.
Who cares about Medicare? Who do you think is the patient population targeted by this treatment - 20 or 30 somethings with private insurance? Not. If Medicare is wavering, this stock could drop back to the teens. This is BAD news!!
Boy talk about a bunch of week knee morons, I sold at around 40 because I was so disgusted at watching after FDA approval losing tens of thousands, now I am really counting my blessings. This stock will be back at 50 after the 1st qtr of showing money going into the coffers. All of these idiots selling at a 18 percent drop after hours is just why I am sitting it out for a couple of months.