Oncology mistake

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Oncology practices and universities are driving the current business. Urology practices are not structured to infuse. They don't have the cash flow or the ability to manage side effects.

Provenge is an oncology product. Urologist will infuse but it will take time.

Upper management fu&k this one up. They oversold a crappy forecast and then refused revise it.

Focus on the business and manage your reputation. That's what we can control!

We have a great product
 






Anonymous said:
Oncology practices and universities are driving the current business. Urology practices are not structured to infuse. They don't have the cash flow or the ability to manage side effects.

Provenge is an oncology product. Urologist will infuse but it will take time.

Upper management fu&k this one up. They oversold a crappy forecast and then refused revise it.

Focus on the business and manage your reputation. That's what we can control!

We have a great product
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The curse of Genentech lives within Dendreon and will thrive until the end of this company which should take one more year at the current rate of cash burn.
 






Anonymous said:
The curse of Genentech lives within Dendreon and will thrive until the end of this company which should take one more year at the current rate of cash burn.
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Urology is a difficult market segment for infusion. They truly are not set up for this either as a facility or by inclination.

Novartis tried 5 times to penetrate this market sector with Zometa with very poor results. The Urologist ia after all a surgeon and earns his living doing procedures not infusions.

Therefore, oncology should be a major focus for this therapy. in addition, since the patient population is defined as having progressed on hormonal therapy, they are even more likely to already be under the care of Oncologists.

Maybe Dendreon should have been looking for a sales force with the appropriate buy and bill prostate cancer experience such as the aforementioned Novartis.
 






Anonymous said:
in addition, since the patient population is defined as having progressed on hormonal therapy, they are even more likely to already be under the care of Oncologists.
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Previous statement is wrong. Urologists usually milk these patients until they have metastatic disease, then they turn them over to the oncs.
 
























Earlier this week, Dendreon (DNDN) shocked investors by scrapping its 2011 sales forecast for its controversial and innovate Provenge prostate cancer vaccine after disclosing that sales were slower than planned. The stated reason was that many doctors, particularly those in smaller settings, were slow to adopt the $93,000 vaccine since they had to wait for reimbursement. Along with unexpected layoffs, the announcement stunned investors, causing Dendreon stock to plunge 60 percent. Wall Street wags began deciphering the extent to which some doctors are truly worried about reimbursement or are simply unethusiastic about the product (back story). We spoke with Leonard Liang, a Los Angeles urologist who is sufficiently enthusiastic about Provenge that he posted his own YouTube video. He maintains he has no ties to Dendreon, but does have reimbursement concerns…

Pharmalot: Before we discuss reimbursement, tell me why you chose to become trained to administer Provenge.

Liang: I think it’s pretty clear. It’s a wonderful advancement for the treatment of prostate cancer and can help many men live longer with very few side effects. I don’t think there’s an argument about that. I think the clinical trial is pretty much pristine and the results are robust. Any patient that’s a candidate should get this.

Pharmalot: So what’s your take on the reimbursement problem that Dendreon execs have described?

Liang: The issue is that doctors may not want to prescribe because they are worried about reimbursement, because it’s so expensive. And it is. It’s a reason why urologists, in particular, who don’t make money prescribing drugs, are probably very slow to start giving this. They’re surgeons and do procedures to make money. Most prostate cancer is diagnosed and treated by urologists. And the average community urologist is not going to want to take the trouble to become a Provenge infusion center for just one or two patients at most a year who they run across and who would be candidates.


Pharmalot: Can you be more specific about reimbursement problems?

Liang: There are two problems – identifying patients and a reluctance to take a financial risk. I’m an early adopter. I think the science is fascinating. It was possible for community urologists to become an infusion center, and I was probably one of the earlier ones. It took awhile to get trained, but eventually, I infused two patients. So far, I’ve given 5 infusions to those two patients. I have one more to give to one of them. So that’s three infusions given to one patient and two to another.

Right now, I have a bill for $155,000 from McKesson (MCK) and I have to start making payments in October. I’ve only gotten paid by Medicare for the first two infusions and I’m billed at $31,000 for each infusion by McKesson. That’s daunting. I don’t keep more than $80,000 in my business checking account. If I don’t get reimbursed by the payer, it’s going to be terrible.

Pharmalot: Can you be more specific?

Liang: This is why I understand doctors are uncomfortable. I’m uncomfortable, too, and I’m a true believer. So I’ve gotten paid by private insurers – a PPO insurer paid for the firstt infusion for one patient given in early June. So for those infusions that cost $31,000 each, Medicare paid 80 percent. With the other 20 percent, I was paid by one patient’s insurance for one of the infusions. They paid the full amount I asked for, which is 6 percent above the cost. Basically, I came out slightly ahead. I made around $1,600 or $1,800. But for the other patient, who has Medicaid as secondary insurance, which is called MediCal in California, I only just got paid. My concern had been that, if Medical doesn’t come through, I took a huge risk and I’m at a loss. I’m still concerned I won’t get paid.

Pharmalot: Why is that?

Liang: It was a big overhang. I feel a lot better, but it doesn’t mean that billing for every patient with MediCal will turn out the same way. Many of these patients are 65 and older, so many could be on Medical as secondary insurance. I’ll give you an example. There’s a doctor in Marina Del Ray, who is a private oncologist, he specializes in prostate oncology and has probably the busiest infusion center in Los Angeles, with maybe 30 to 50 patients already infused. I talked to his billing person and they told me they don’t infuse patients with Medical as secondary insurance, they only take private insurance. Why? They don’t take the risk of not getting paid by MediCal. It’s not just me who worries about this.

Pharmalot: And the reason is…

Liang: MediCal often stiffs doctors. It’s a hard concept for folks who aren’t doctors to understand. Often there are long delays and often non-payment for physician services. Like anything else, the code may not be right. There’s a million reasons how insurer or the state can try to keep payment or reduce payment. The concern among physicians is for patients without good insurance, they are just not going to take the risk. Historically, you know, doctors don’t want to take risks.

Pharmalot: So what do you think this means going forward?

Liang: I think what’ll happen in the future is that not many centers will give this. It’s not like a pill that all urologists can write a prescription for. Only a certain number of centers will give this. Community urologists largely won’t. I’m trying to become the community urologist that other community urologistss refer to. I think 99 percent of urologists will not be infusion centers and not give it in their clinics.

The company is saying it’s the urologist’s fault for messing up their cash flow. But I don’t think it’s an issue that can’t be solved. I’m surprised they didn’t do more research to understand this point. It won’t be like every other urologist in the US will start giving this. I think they misjudged. But in fairness, there’s never been anything like this. It’s unique. It’s expensive, although when you compare it to chemotherapy, I don’t think the price is out of line, especially since this is something you have to make. But it’s a new concept for oncologists and urologists to understand.
 






This has nothing to do with Genentech and everything to do with arrogance. We launched this drug thinking the world was clamoring for this product when in fact it was not. Then we decided that it would be a urology product. Urologists by and large will not undertake infusion therapy on. They are surgeons! Two other companies have tried this and have not been successful. The continued arrogance and sheer inward thinking is bringing this company to its knees yet it continues to ignore what the market is saying. Urologists will minimally adopt and medical oncologists will treat more when we can explain how the hell this thing is working.

Funny to hear our very own three stooges (Gold, Bishop, and Schiffman) try to explain why Provenge isn't living up to expectations. First, its reimbursement, next its community expansion, third, its academic is driving the business, and fourth, its reimbursement. These guys sounded like amateurs at the very least and sophmoric at the very best. But, do they really give a crap. Of course not. They have the ability to unload company stock right before anyone is privy to bad news. PATIENTS FIRST! By the way Mitch, maybe its time to break out your mother's photograph again for some heart-tugging emotional speech.

So, from now on when a PIP is delivered we should be able to use words like cost density and modest trajectory to rebut the sham that we're being put through. It's now time for Gold and Bishop to get their PIPs. It's time for them to go.
 




































Anonymous said:
This has nothing to do with Genentech and everything to do with arrogance. We launched this drug thinking the world was clamoring for this product when in fact it was not. Then we decided that it would be a urology product. Urologists by and large will not undertake infusion therapy on. They are surgeons! Two other companies have tried this and have not been successful. The continued arrogance and sheer inward thinking is bringing this company to its knees yet it continues to ignore what the market is saying. Urologists will minimally adopt and medical oncologists will treat more when we can explain how the hell this thing is working.

Funny to hear our very own three stooges (Gold, Bishop, and Schiffman) try to explain why Provenge isn't living up to expectations. First, its reimbursement, next its community expansion, third, its academic is driving the business, and fourth, its reimbursement. These guys sounded like amateurs at the very least and sophmoric at the very best. But, do they really give a crap. Of course not. They have the ability to unload company stock right before anyone is privy to bad news. PATIENTS FIRST! By the way Mitch, maybe its time to break out your mother's photograph again for some heart-tugging emotional speech.

So, from now on when a PIP is delivered we should be able to use words like cost density and modest trajectory to rebut the sham that we're being put through. It's now time for Gold and Bishop to get their PIPs. It's time for them to go.
Click to expand...

Rosen got PIPS today.
 






Lets all agree that no matter what, any physician, urologist, medical oncologist or etc should practice medicine and prescribe based on merritt and the right therapy for patients rather than financial reasons.
 






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