We've Got You Covered
Dendreon, the makers of PROVENGE, are committed to helping your practice and your patients simplify the insurance process.
PROVENGE reimbursement is comprehensive:
- Medicare—All Medicare Administrative Contractor regions cover PROVENGE for use within the FDA-approved label per the National Coverage Determination
- Commercial—Health care plans representing approximately 99% of patients with private insurance cover PROVENGE for use within the FDA-approved label
The average time period from bill to payment with Medicare and commercial insurance is approximately 30 days.
In addition to the programs below, you can find a number of reimbursement resources here to help you navigate the insurance process, from patient enrollment through the appeal process for denied claims.
For more information, visit PROVENGEReimbursement.com.
Dendreon ON Call
Dendreon ON Call is designed to be a comprehensive and convenient resource for health care professionals seeking to use PROVENGE for their patients. When a patient begins therapy with PROVENGE, dedicated Dendreon ON Call reimbursement coordinators will provide support with the reimbursement process, and local field reimbursement business managers will be available to answer questions upon request.
Examples of assistance that a reimbursement coordinator can provide include:
- Patient enrollment, to ensure accuracy and minimize delays
- Benefits verification
- Prior authorization criteria support
- Claims appeal support
Although PROVENGE has robust coverage with major commercial and public payers, Dendreon is committed to helping your patients who are eligible for treatment gain access to patient assistance.
Patient Assistance Programs can help your patients in many ways. Dendreon has continued to enhance the Patient Assistance Programs available by introducing PROvide, a program specifically designed for patients who are covered by commercial insurance.
Learn more about patient assistance from Dendreon.
CMS Finalizes National Coverage for PROVENGE
On June 30, 2011, the Centers for Medicare and Medicaid Services (CMS) released a National Coverage Determination (NCD) that clarifies reimbursement of PROVENGE for Medicare beneficiaries.
- Effective for claims with dates of service on or after July 1, 2011, Medicare covers PROVENGE for patients with:
- Asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer
- The NCD is binding on all Medicare Administrative Contractors (MACs) covering all regions across the US
The NCD issued by CMS for PROVENGE applies to Medicare payers only. To confirm coverage of PROVENGE by non-Medicare payers, please visit Dendreon ON Call online, or call 1-877-336-3736.