Nobody wants to pay for Dendreon’s cancer vaccine, it seems.

With Medicare officials in the thick of their yearlong review of the effectiveness of Provenge, a new survey of insurance companies reveals that the majority of health providers plan to restrict patient access to the therapy.

Physicians have hailed Provenge, approved last April by US regulators, as a groundbreaking new therapy for advanced prostate cancer. But many have also voiced reservations about the first-of-a-kind vaccine — which costs $93,000 for a course of treatment, and extends life span by an average of only four months — for offering too little for too much.

Dendreon has been plagued with problems since received the blessing of the US Food and Drug Administration on 29 April. Shares have plunged almost 50% over concerns that the Seattle-based biotech won’t be able to produce enough drug supply to meet demand. And the Centers for Medicare and Medicaid Services’ announcement on 30 June that it was deciding whether to cover the pricey medication added a further blow.

Now comes a survey of directors from 50 national and regional health providers, which finds that around two in three insurers plan to restrict access to the vaccine in some form. Many companies say will require some form of prior authorization such as evidence that alternative courses of hormonal or chemotherapy therapy have not worked or documentation of a full-blown metastatic disease for reimbursement, Pharmalot reports. Aetna, for example, already requires pre-certification.

The troubles engulfing Provenge are likely to be shared by the wave of other cancer vaccine developers hoping to follow in Dendreon’s footsteps. For a who’s who of late-stage cancer vaccine companies, see our story from last month’s issue of Nature Medicine.

Image: Nature Reviews Drug Discovery