We Need Your Help Insuring Medicare Funding for Provenge- Please read and respond

[Guest guest]

FROM TODAY ON THE ADVANCED PROSTATE CANCER BLOG AT:       www.advancedprostatecancer.net How are funding decisions made for Medicare and Medicaid?  What drugs are to be funded?  These questions have recently come to our

attention as many of us have attempted to have Medicare fund our use of Provenge. 

 

The administration of Medicare is actually broken into 15 different

regions, or MACs (Medicare Administrative Contractors).   Each

MAC is responsible for deciding what treatments and drugs are to be reimbursed

by Medicare.  Initially, decisions are

made at the MAC level, so it is possible that some MACs will approve a

treatment or drug while others will not. 

 

In some instants, the Federal organization, the Center for

Medicare & Medicaid Services (CMS) , will step in and create a national

policy for all the MACs.    In the

instances of funding for Provenge, CMS has just announced that it will be

reviewing Provenge and eventually make a national policy decision on

reimbursement.  This process can easily

take up to one year!  In the mean time, CMS

has instructed the MACs to continue to make individual regional decisions.  So, until CMS provides a national guideline,

some MACs will pay for Provenge, some may not pay and others will continue to

make you jump through hoops to get it covered! 

 

CMS has established a thirty day (30) (the month of July) public

comment period for us the  public to add our

own “testimony”.   I believe that a large

public demand will help push an approval for all men who are on Medicare and who

need Provenge to extend their life.  Do

not under estimate the power of numbers; take a lesson from the breast cancer

community.   We can be as strong as the

breast cancer community and rally around the national approval of Provenge for

men on Medicare and Medicaid.

 

Comments can be left at:  

 http://www.cms.gov/mcd/m_nca.asp?id=247:

 

I have included my comments which you are free to copy.  Better, modify mine or write your own.   It will take only a few minutes of your

time, but you could help extend someone’s life. 

 

MY COMMENT:

Sipuleucel-T (Provenge) should, without question, be

approved by CMS nationally for all men with advanced prostate cancer.  Very quickly, after it received approval from

the Food and Drug Administration (FDA), the National Comprehensive Cancer

Network updated its prostate cancer management guidelines to recommend, as a  category 1 recommendation, the clinical use

for Sipuleucel-T for men with minimally symptomatic disease, an ECOG

performance score of 0 or 1, and a life expectancy of at least 6 months.  A category 1 recommendation means that, “The

recommendation is based on high level evidence (use of randomized controlled trials).

 

Multiple blind clinical trials demonstrated a very clear

survival advantage for men in the treatment arms.  The survival advantage was best (six months) with

men who were in the age range of being Medicare eligible.   

 

National coverage for Sipuleucel-T should be granted immediately.   According

to the Surveillance, Epidemiology, and End Results

(SEER) Program of the National Cancer Institute (NCI), 32,050 men will die in

2010 from advanced prostate cancer.  Continuing

to delay CMS’S approval would be unethical. 

We cannot afford to continue to tolerate an unnecessary delay while 32,050

men face their death.  These men are our veterans,

our fathers, our husbands, our partners and our brothers. How can we abandon

them now?    

T Nowak, MA, MSW

Director of Advocacy & Advanced Prostate Cancer Programs

-- T Nowak MA, MSWDirector for Advocacy and  Advanced Prostate Cancer Programs, Malecare Inc. Men Fighting Cancer, TogetherSurvivor - Recurrent Prostate, Thyroid, Melanoma and Renal Cancers

www.advancedprostatecancer.net - A blog about advanced and recurrent prostate cancerwww.malecare.com - information and support about prostate cancer

http://health.groups.yahoo.com/group/advancedprostatecancer/ - an online support group for men and their families diagnosed with advanced and recurrent prostate cancer