DNDN – I’ve seen several recent posts on various message boards asserting that Provenge is a shoo-in to be reimbursed for off-label use in early-stage prostate cancer. For the most part, these posts are clueless about the way cancer drugs in the US are reimbursed.
Without explicit support in the NCCN compendium (or one of the three other compendia used by CMS), reimbursement by Medicare is highly unlikely. If Medicare does not reimburse for off-label use of Provenge, it’s unlikely that private insurance will do so.
For Provenge to be included in the NCCN compendium will require compelling efficacy data from at least a large phase-2 study.
“The efficient-market hypothesis may be
the foremost piece of B.S. ever promulgated
in any area of human knowledge!”
