Yes, but not like this. One could readily see orphan genetic conditions drugs as having the asme problem, but these are almost all young people's diseases (to start) and reimbursed largely by private insurers who will pre-approve treatment.
This is really a fairly unique combination of high expense inside one month in a Medicare population.
If Cardinal or one of the other common practice funders allows a $3M line of credit for Provenge and the onc practice puts 15 patients on this month and 15 on in the second month, that's the $3M right there. If the MAC is on a 60-day pay because of a paper generic code system and a funky interpretation of eligibility, that practice can't sell ANY cancer drug - much less Provenge -- in month 3.
This is why the Q-code and the NCD should make a difference. The NCD eliminates the funky criteria and the Q-code makes reimbursement requests electronic.
Remember, CMS doesn't administer Medicare at the doctor/patient level. 15 private companies do. Each has different procedures and is better or worse about payment speed. Each has different ideas of "fast" reimbursment and customer service. None will pre-approve a treatment. Makes for odd side effects...
Unless otherwise indicated, this is the personal viewpoint of David
Miller and not necessarily that of Biotech Stock Research, LLC.
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