A new survey of insurers conducted by Reimbursement Intelligence indicates that Dendreon's Provenge is likely to face flat uptake over at least the next 6 months. Cited reasons for this stem frm both physician and insurer perceptions about the new higher priced cancer drug.
Physicians responding to the survey indicated low prescribing rates due to:
- Limited clinical value
- The drug's high cost
- Lack of qualifying patients
- Smaller number of centers willing to administer Provenge
- Stricter utilization policies
- Complicated treatment regimen
Insurers for the most part indicated a willingness to reimburse for the drug provided it was being utilized on label. Although, some industry observers indicate that 3rd party payers may be using more stringent criteria to determine reimbursement than Medicare requires.
This survey would seem to validate that Provenge is going to have a tougher time breaking into the market than perhaps first expected -- until it can establish a clinical record. Of course, slower uptake will increase the time to establish a record. Based on this, it seems rationale that Dendreon backed off its bullish forecast but of curse raises the question as to why it was so bullish in the first place. Regardless, it's clear Dendreon management has its work cut out for it.
Posted by Bruce Lehr Aug 25th 2011.