Replies to post #124404 on Biotech Values

[masterlongevity]

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.

[AlpineBV_Miller]

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...