PROVENGE has Robust Coverage

In 2011, CMS issued a National Coverage Determination (NCD) and Q-code (Q2043) for PROVENGE to help simplify patient coverage criteria and expedite electronic billing and payment.

Across commercial and government payers
  • Medicare: All Medicare Administrative Contractors cover PROVENGE for use within the FDA-approved label per the National Coverage Decision
  • Commercial: Health care plans representing approximately 99% of patients with private insurance cover PROVENGE based on the FDA-approved label
  • Medicaid: All states have their own Medicaid program and develop their own coverage policies for various drugs and services

Support to Simplify and Facilitate Reimbursement for PROVENGE

Dedicated Dendreon ON Call reimbursement coordinators can provide:
  • Coding and billing resources to support claims submission, including sample forms and letters
  • Forms that are tailored to both hospital outpatient departments and physician practices
  • Claims form reviews, prior to submission
  • Real-time tracking status on submitted claims

Our Distribution Partners

PROVENGE is available from:

Group Purchasing Organizations (GPOs)

Extended payment terms are provided through your distributor.

INDICATION

PROVENGE® (sipuleucel-T) is an autologous cellular immunotherapy indicated for the treatment of asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer.

IMPORTANT SAFETY INFORMATION

Acute Infusion Reactions: Acute infusion reactions (reported within 1 day of infusion) may occur and include nausea, vomiting, fatigue, fever, rigor or chills, respiratory events (dyspnea, hypoxia, and bronchospasm), syncope, hypotension, hypertension, and tachycardia.

Thromboembolic Events: Thromboembolic events, including deep venous thrombosis and pulmonary embolism, can occur following infusion of PROVENGE. The clinical significance and causal relationship are uncertain. Most patients had multiple risk factors for these events. PROVENGE should be used with caution in patients with risk factors for thromboembolic events.

Vascular Disorders: Cerebrovascular events (hemorrhagic/ischemic strokes and transient ischemic attacks) and cardiovascular disorders (myocardial infarctions) have been reported following infusion of PROVENGE. The clinical significance and causal relationship are uncertain. Most patients had multiple risk factors for these events.

Handling Precautions: PROVENGE is not tested for transmissible infectious diseases.

Concomitant Chemotherapy or Immunosuppressive Therapy: Chemotherapy or immunosuppressive agents (such as systemic corticosteroids) given concurrently with the leukapheresis procedure or

PROVENGE has not been studied. Concurrent use of immune-suppressive agents may alter the efficacy and/or safety of PROVENGE.

Adverse Reactions: The most common adverse reactions reported in clinical trials (≥ 15% of patients receiving PROVENGE) were chills, fatigue, fever, back pain, nausea, joint ache, and headache.

Click here for Prescribing Information.