Provenge and Lymph Node Involvment

[Guest guest]

Today's post on the Advanced Prostate Cancer Blog pertains to private insurance company problems (not medicare or medicaid) and reimbursement for Provenge.  I have had two separate reports of private insurance companies rejecting reimbursement for men with PSA and lymph node only involvement only (no bone mets) without a positive biopsy of the node. 

This determination runs counter to the findings in the clinical trial used by the FDA to approve Provenge.  If you have had any experience with private insurance companies and a positive lymph node please let me know what was your experience.

THANKS,  A Possible Provenge Private Insurance Hitch In Men with Advanced Prostate Cancerhttp://advancedprostatecancer.net/?p=3340

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

Speaker, Advocate and Educatorwww.advancedprostatecancer.net - A blog about advanced and recurrent prostate cancer

www.malecare.org - information and support about prostate cancerhttp://health.groups.yahoo.com/group/advancedprostatecancer/ - an online support group for men and their families diagnosed with advanced and recurrent prostate cancer

[Guest guest]

Sent: Thursday, July 5, 2012 11:26 AM

> Today's post on the Advanced Prostate Cancer Blog pertains to

> private insurance company problems (not medicare or medicaid)

> and reimbursement for Provenge.  I have had two separate

> reports of private insurance companies rejecting reimbursement

> for men with PSA and lymph node only involvement only (no bone

> mets) without a positive biopsy of the node.

> This determination runs counter to the findings in the clinical

> trial used by the FDA to approve Provenge.

> If you have had any experience with private insurance companies

> and a positive lymph node please let me know what was your

> experience.

,

If a patient is believed to have lymph node only involvement,

wouldn't radiation be the standard of care?  It could actually

cure the cancer, not just hold it at bay.

What would be the rationale for preferring Provenge?

Thanks.

    Alan

[Guest guest]

Alan,An excellent comment and yes I agree as long as the man has had one of the specialized scans available from either the Mayo Clinic or Sand's Lake to insure that the disease has not spread to other parts of the body.  I believe that the vast majority of men do not avail themselves of these options since they are not well known by most oncologists and are not FDA approved so they would not be cover by insurance.

Usually men have MRIs, PET scans etc. which are very localized and not sensitive enough to pick up systemic disease.  I do think that these scans are a better alternative, but in the current real world most men are not offered the opportunity to have trhese specialized scans.

 

 

Sent: Thursday, July 5, 2012 11:26 AM

> Today's post on the Advanced Prostate Cancer Blog pertains to

> private insurance company problems (not medicare or medicaid)

> and reimbursement for Provenge.  I have had two separate

> reports of private insurance companies rejecting reimbursement

> for men with PSA and lymph node only involvement only (no bone

> mets) without a positive biopsy of the node.

> This determination runs counter to the findings in the clinical

> trial used by the FDA to approve Provenge.

> If you have had any experience with private insurance companies

> and a positive lymph node please let me know what was your

> experience.

,

If a patient is believed to have lymph node only involvement,

wouldn't radiation be the standard of care?  It could actually

cure the cancer, not just hold it at bay.

What would be the rationale for preferring Provenge?

Thanks.

    Alan

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

Speaker, Advocate and Educatorwww.advancedprostatecancer.net - A blog about advanced and recurrent prostate cancer

www.malecare.org - information and support about prostate cancerhttp://health.groups.yahoo.com/group/advancedprostatecancer/ - an online support group for men and their families diagnosed with advanced and recurrent prostate cancer