Scheduling and Administering Leuprolide: Key Challenges and Practical Solutions


Key opinion leaders briefly review the key challenges in scheduling leuprolide administration for patients with advanced prostate cancer, including treatment delays, disease breakthrough, and insurance reimbursement, and share solutions to overcome these challenges.


Paul R. Sieber, MD: I think the idea that you brought up, which I think is outstanding, is we have breakthroughs partly because the patient doesn’t come in at that 3-month interval. You’re off, I have a different process. My ADT [androgen-deprivation therapy] is done through a separate clinic. The doctor is not ever even involved when you’re getting your injection. So...we divorce the injections from their visits. So, they’re scheduled to come 24 weeks, not at 6 months, or with the newer agent, mesylate...they’re coming back at 6 months. And I don’t want to say, I’ll be back at 7 months. They’re just having problems. We stick to that 6 months, but at least we don’t have to worry about that. They’re coming back at 12 weeks, they’re coming back at 16 weeks, they’re coming back at 4 weeks. So, I think that’s a big point [where] we contribute to the problem by not going to the 6-month cycle. Chris, you were going to say something?

Christopher M. Pieczonka, MD: One little practical thing that we found out the hard way is that our local payers are paying for a total of 90 mg worth of leuprolide a year. And so, we got a couple of denials and learned very hard and very quickly that when we give somebody, let’s say, a 4-month injection, then they’d come back and get 6 months. And then at the end of the 6 months, they’d be getting another 6 months. So, the way that insurance is viewing this is they’re saying that you’re getting all of that dosing above 90 mg within that 12-month period. So we got denials on that. So that essentially very quickly got us out of the business of playing these games and trying to figure out, Well, insurance company A is going to do that, insurance company B.... So, from a practical business standpoint, that has really simplified things for us because we got quite a bit of denials and [unknown] to us, all of a sudden, now that’s not kosher. And so, you’re sitting on eating the cost for a couple of those injections, and no one’s happy about that.

Aaron Berger, MD: If there were any clinical benefit to doing it more often, then fine. But since there really is none, it just makes things more complicated because especially with persistent staff shortages that we still have going on, we have staff bouncing around from location to location at some points, and they’re looking on the schedule and saying, “Oh, this patient’s due for an ADT injection. They may be used to grabbing the 6, but they’re only approved for the 3 or vice versa. So, again, eliminating mistakes. You don’t want to be going back to your insurance and say[ing], “Well, this happened. We had this error. Can we still get paid?” Because you don’t want to be eating a couple of thousand dollars of injection just because someone’s not paying attention. So eliminating as many of those potential errors as possible, I think, is really what we need to do because the staffing shortages and educational part of doing this are not going to get better anytime soon.

Transcript is AI-generated and edited for clarity and readability.

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