genentech has a much more sophisticated system for helpin practice managers cover initial costs. It is no longer considered a successful commercial strategy to only have a good product and a good marketing plan. Companies have to build in added services to their launch plans for drugs to be initially successful. This should not ahve been a surprise to DNDN. THis is the kind of thing big pharma does well. they have tons of staff who strictly focus on payors and helping practice managers cover expenses until the drug gets off the ground and the practice managers learn to manage the payments and reimbursement cycle for these expensive drugs.
Although much less expensive, Genentech had a similar but much smaller issue with Lucentis. Retinal specialists were not used to shelling out big bucks upfront for therapy and not being paid through medicare until 2-3 doses had been given. Granted, this is peanutts compared to provenge's $93K. But Genentech hired a team of marketers and health economists strictly focused on the practice managers as they were not used to these costs.
DNDN should have been speaking to practice managers before launch and had this figured out by now. the drug could be in much better hands.