I think there is a lot of Monday-morning quarterbacking going on here on this issue. How many people would believe that doctors would withhold access to a proven life-extending drug because of cash flow issues at their practice? Remember, these urologists could simply refer these patients to a larger practice or an academic center and they could get treated. Instead, they are just sitting on them.
I spoke to a different oncologist this morning. Her group just can't take the financial chance of not getting Provenge reimbursed. You sometimes have to wait 6 months to get paid. She has taken hits on Avastin and even procrit. Only very large groups can do it. How much money do you think lays around in MD's business accounts? For example my group grosses 9 million a year and we almost always have under 50k in the account.
Referal to Miami according to her, is not that easy. The specialists are difficult to get a hold of and the patients (elderly) aren't jazzed up for traveling an hour on the freeway each way.
Additionally Apheris (collecting the patients blood) is a bit of a pain for the doctors and the patients to set up and go through.