CMS issues favorable decision on prostate Ca immunotherapy coverage

The advanced prostate cancer autologous cellular immunotherapy sipuleucel-T (Provenge) improves health outcomes for Medicare beneficiaries with asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer and thus is reasonable and necessary for that indication, according to a proposed decision memo from the Centers for Medicare & Medicaid Services.

According to Dendreon Corp., the maker of sipuleucel-T, Medicare beneficiaries currently are able to access sipuleucel-T, as Medicare Administrative Contractors covering all 15 regional territories have established coverage guidelines and/or provided physicians with written or verbal guidance on coverage. The American Medical Association said that, if finalized, the national coverage determination would apply the same coverage standard to all beneficiaries.