USA's CMS to cover infusion costs associated with Dendreon's Provenge

Sales of Dendreon’s (Nasdaq: DNDN) new prostate cancer treatment Provenge (sipuleucel-T) have been disappointing so far, partly as a result of its high cost of around $93,000 per round of therapy and the fact that, despite being approved by the US Food and Drug Administration in April 2010, Medicare did not make a final decision to cover the product’s cost until June this year.

However, there may be help at hand in that the US Centers for Medicare and Medicaid Services (CMS) updated its policy to now cover the infusion costs associated with the administration of Provenge. With this decision, the coverage of the product is now consistent with all other infused biologics.

The CMS has issued two new transmittals that instruct the local Medicare Administrative Contractors (MACs) that the costs associated with administering Provenge will now be covered and can be billed separately. Additionally, the CMS decision will retroactively cover claims for costs associated with the administration of Provenge effective for dates of service on or after June 30, 2011, allowing physicians to collect for all previous infusions.