Biotech Values

[dewophile]

This 1 doc has tried prior auth. route (as reco'd by drug reps) and been denied by each of the above 3 insurance companies, even though some of these pts require frequent INR checks for coumadin levels

forget for a moment what is best for the patient - the absurdity on an economic level (assuming for a moment coumadin+INRs is more costly than pradaxa alone) actually doesn't surprise me at all

we try negotiating IVF reimbursement and can show say 20% higher success rate than neighboring centers in network and ask for 10% higher reimbursement and are flatly denied. even worse we show lower multiple and high order (eg triplet) rates to boot, which would greatly lower costs for insurance companies (think of what a day in the NICU costs) and we still can't squeeze a penny of added reimbursement for a cycle
it's just plain dumb

i should note there is one payer that now looks at multiple rates and factors this in to whether or not to accept you in their plan as well as reimbursement, but that represents perhaps 2% of covered lives in my area - the rest are idiots