Provenge, also known as the "prostate cancer vaccine," was met with a great deal of excitement when it was first introduced to the world of prostate cancer. It has a hefty price tag, however, and there was controversy as to whether Medicare (or private insurance companies) should pay for it.
The FDA approved of its use, which cleared a major hurdle toward more widespread use, but with its high price, most men would not be able to afford the drug if it were not covered by insurance of some kind. So, will insurance pay for Provenge?
Medicare made a final decision to pay for Provenge on June 30, 2011.
The decision by Medicare to pay for Provenge is a big one because typically, most private insurance companies follow Medicare in terms of what is covered and what is not. Each private insurance company ultimately makes their own decision about whether to cover a treatment, but the decision by Medicare means that most will likely cover it.
As is often the case with treatments, Medicare will not pay for Provenge unless it used according to approved criteria. Namely, only men with metastatic prostate cancer that no longer responds to hormone therapy will be eligible to have their Provenge covered.
The decision by Medicare to cover Provenge is not without controversy, as the drug carries a price tag of $93,000 for a complete treatment.