my office time to be split between Seattle and New Jersey.
X: You’ve got so much to talk about here, I haven’t even brought up reimbursement. Is that still a major issue you need to wrestle to the ground, or how is that being taken care of?
Joe DePinto: We had an excellent NCD [National Coverage Determination from the Centers for Medicare and Medicaid Services] which was issued last year. The benefit of that is over time, reimbursement confidence continues to grow in the clinics, both in the oncology and urology side. They are becoming more confident. There’s a Q code now [a reimbursement classification used by Medicare]. They can do electronic billing. The time to payment is getting better, it’s 30 days or less, which is excellent. It’s really unprecedented for NCDs. Mitch and the team put a lot of effort into making sure that would allow patients to have access to Provenge. Reimbursement confidence continues to build across our market segments. Having that coverage, the Q code, the ability to file electronically, is big.
X: And how many patients does it take for them to gain confidence they’ll get reimbursed in a timely manner?
JD: It’s highly variable, depending on the account. But what typically happens is you get that one claim through, you get more confidence as another claim goes through. It’s like anything where people decide to develop a process to make sure they’re not missing anything, and they handle [Provenge billing] effectively. I see it becoming more of an SOP [standard operating procedure] within oncology practices, as they determine processes for “this is how it works for billing with Provenge,” just like you have to have a process for billing with any other therapeutic given in those practices.
John Johnson: The challenge in the beginning was if you put five patients on Provenge, and you’re not getting paid for six months, that’s a lot of Provenge on your practice. The good news is that the time piece of the equation has really gone away. We still have to make sure we go through a process with payers up front to get pre-approval.
I was in a big practice last week where they’ve developed a [Provenge billing] system. They have steps where they verify original coverage, then do co-pay verification. They have a spreadsheet with columns across the top for every patient. Once they did that, once they saw the payment coming in, they had all the patients being treated by a specific nurse, and all the payments being handled by a specific billing manager. They were rolling. And the reason they were is that they’ve seen it happen five to six times—I think this practice was on its 13th patient, and they hadn’t seen any problems at all. But what they had to do was have a process, and have it centralized. It’s working great for them, but not everybody is there yet.
X: And now you’re looking to pick up more community oncologists, as well as urologists who can prescribe Provenge. Or is it urologists and then oncologists, in that order?
JD: It’s interesting, because we have bifurcated our marketing effort into the urology and oncology side. Oncology is still a large part of our business, but urology, we see as a big part of the future, and we really want to grow that part of the business. We have separate messages for them, because the messages are slightly different. We have different types of value propositions for different specialties. The urologists tend to see those patients a little earlier. We’re talking to them about intervention a little earlier, at a lower PSA [prostate-specific antigen] level. We’re talking to them about what percentage of patients with a lower PSA are metastatic [meaning their disease has spread]. Oncologists tend to see patients a little bit later. But all along that continuum there’s consistency to the story. Mark [Frohlich] talked about wanting Provenge to be the foundation of care, and that’s exactly where we want it to be. We have a urology marketing team, and an oncology marketing team, and a field sales force that calls on both.
X: You must be very curious about the data coming out at ASCO in June from your competitor, J&J’s Zytiga, which showed in the pre-chemo setting that it was offering a benefit. How might this change the landscape for you?
JJ: It wasn’t a surprise to us. We all expected it in this time frame, and for it to be positive.
JD: Our experience says that competition grows a market. Having another voice
