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Reimbursement Issues in Prostate Cancer, Part I

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Raoul Concepcion, MD, FACS, begins the conversation by noting that urology as a business faces reimbursement and operational challenges.

Steve Dobbs, FACHE, says that his practice’s latest reimbursement issue has been with sipuleucel-T (Provenge), which is an expensive drug. According to Dobbs, the process to guarantee reimbursement is complicated. Initially, Dendreon completes the verification of benefits and the practice does a secondary review. Throughout the process, nurses are in contact with patients to notify them of any co-pay issues.

Administering sipuleucel-T has become such a large financial commitment, Dobbs says, that it’s now a separate line item in monthly board meetings. With regards to LHRH treatments, such as leuprorelin (Lupron), Dobbs’ practice reviews the reimbursement process on a quarterly basis.

The question many urologists face now is selecting the most appropriate treatment as new costly therapies gain approval. To solve this problem, medical experts discuss the clinical side of administering new drugs, while operations committees decides which agents to carry, and management teams negotiate costs and GPO relationship issues.

View part II of this conversation

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