CMS now covering prostate Ca immunotherapy infusion costs

Dendreon Corp. has announced that the Centers for Medicare & Medicaid Services has updated its coverage policy to now cover the infusion costs associated with the administration of the advanced prostate cancer immunotherapy sipuleucel-T (Provenge).

With this decision, the coverage of sipuleucel-T is now consistent with all other infused biologics, according to the company.

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

CMS issued a final national coverage decision (NCD) for sipuleucel-T on June 30, 2011, requiring Medicare contractors to cover the use of sipuleucel-T for treatment of asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer. The NCD standardized coverage processes across the country for all Medicare patients with asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer and provided the local MACs specific criteria, consistent with the label, on how sipuleucel-T should be covered.

Since the issuance of the final NCD and the activation of a sipuleucel-T-specific Q-code, which accelerates electronic adjudication of claims, the reported average time to payment for physicians is approximately 30 days, Dendreon said.

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