Provenge (sipuleucel-T) is a brand-name injectable drug prescribed for a type of metastatic prostate cancer in adults. The cost of the drug, with and without insurance, can depend on several factors, such as whether Provenge has a savings program.
As with all medications, the cost of Provenge can vary. Factors that may affect the price you’ll pay include:
- your treatment plan
- your insurance coverage
- the pharmacy you use
- the cost of the visit to your healthcare professional to receive doses of Provenge
- whether Provenge has a savings program (see the “Financial and insurance assistance” section below)
To find out what the cost of Provenge will be for you, talk with your doctor, pharmacist, or insurance provider.
Provenge contains the active ingredient sipuleucel-T, and it’s available only as a brand-name biologic drug. It doesn’t come in a biosimilar version. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Also, biosimilars tend to cost less than brand-name medications.
WHY ARE COSTS DIFFERENT FOR BIOLOGIC DRUGS VS. BIOSIMILAR DRUGS?Biologic drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to
12 years . When the biologic drug’s patent expires, multiple manufacturers can create biosimilar versions. This marketplace competition may lead to lower costs for biosimilars. Also, because biosimilars are very similar to biologic drugs, they don’t require the same costly testing.
If you need financial support to pay for Provenge, or if you need help understanding your insurance coverage, help is available. For example:
- A program called PROvide is available for Provenge. For more information about this copay assistance program and to find out whether you’re eligible for support, call (844) 244-1309 or visit the program website. Other resources include:
- assistance options for those with government-funded insurance, such as Medicare or Medicaid
- financial support for those who are underinsured or don’t have insurance
- transportation assistance for those who can’t get to their appointments for Provenge treatment
- Some websites provide details about drug assistance programs, ways to make the most of your insurance coverage, and links to savings cards and other services. Two such websites are:
To learn more about saving money on prescriptions with or without insurance, check out this article.
Below is information you may want to consider if you have insurance and receive Provenge.
Prior authorization: If you have insurance, your insurance company may require prior authorization before it covers Provenge. This means the company and your doctor will discuss Provenge in regard to your treatment. The insurance company will then determine whether the medication is covered.
If a drug requires prior authorization but you start treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Provenge requires prior authorization.
Type of insurance coverage: Your doctor or another healthcare professional can give you Provenge as an intravenous (IV) infusion. If you have insurance, the price of your Provenge doses may be billed through your medical coverage instead of the prescription drug portion of your insurance plan. This depends on your specific insurance plan and where you receive your Provenge doses, such as at your doctor’s office, an infusion clinic, or a hospital.
If you have questions about this process, contact your doctor or your insurance provider.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.