Is this drug worth it? Is it rationing if the answer is "no"?

On July 1, the Wall Street Journal reported that Medicare had decided to cover Provenge, a new drug for treatment of advanced prostate cancer.

According to the article, men with advanced prostate cancer and treated with Provenge in clinical research lived a median of about 26 months, or about four months longer than patients who received a placebo.

Translated into English, this says half the Provenge patients lived at least 4 months longer than patients treated with sugar water. The other half lived fewer than 4 months longer.

The punch line is the cost--about $93,000 per course of treatment. (Not a typo.)

I have a question. Why shouldn't Medicare allow patients a choice between Provenge - and a cash payment of $50,000?

Why ask? Well, for starters because this drug delivers minimal benefit, patients might not want it especially if another option were available; the cash option might be a much more welcome way for the federales to help families cope with the loss of a loved one; having no choice means taxpayers will shoulder much higher costs; there's no telling WHAT Medicare was really thinking anyway; and the only party that clearly benefits seems to be Dendreon, the drug manufacturer.

So - is this drug worth it? Is it rationing if the answer is "no" ?