Medicare Evidence Development and Coverage Advisory Committee Recommends Medicare Reimbursement of Provenge

Yesterday, the Medicare Evidence Development and Coverage Advisory Committee’s (MEDCAC) vote on a number of questions amounted to a recommendation to the Centers for Medicare and Medicaid Services (CMS) to cover Provenge, a therapeutic vaccine for men with advanced prostate cancer.  While the recommendation was not overwhelmingly enthusiastic, Provenge clears one hurdle on its way to Medicare coverage.  CMS is expected to make its final recommendation in the next few months.  This is a small victory for the estimated 100,000 men who have advanced prostate cancer and the process has not been without controversy.

While I am not clinical, I have worked in pharmacy benefit management for several years and have a sufficient understanding of drugs and where pharmaceutical research is and what products the manufacturers intend to produce.  That said, this recommendation is a small victory for all of us.  Any impediment or indication that Medicare, would not reimburse such a drug, has the potential consequence of limiting future innovation.  The drug required almost a 1 billion dollar investment, 15 years, and 15 clinical trials.

Again, I am not in the pharmaceutical field, but from my point of view, it must be possible for researchers to benefit from Dendreon’s innovation and investment.  This should lead to more breakthroughs in the future, at a reduced cost when the drug comes to market.

As consumers, we are used to new technologies being the most expensive.  When a new drug comes to market using a new method of allowing men with advanced prostate cancer to live longer with a better quality of life, some balk at the price.  When a new LCD TV or IPhone comes to market, consumers rush to the store to pay for the new technology.  The price eventually comes down as more manufacturers produce the technology.

And so is the same with drugs.  Obviously there is a huge price reduction when the generic comes to market. But we should all benefit from new and less expensive drugs as more manufacturers learn how Provenge works and tries similar research based on its concept, even before it comes off patent.

Yesterday was probably an unremarkable day for most Americans, but the decision of a small, largely unknown advisory panel may allow a father to see his daughter’s wedding next year without the complications of chemotherapy.  So for him and her, yesterday was a great step forward whether they know it or not.

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