RMB Insurance co pays ...or lack of coverage ...ultimately determine which drugs patients get or can afford .
Some drug companies set unreasonably high prices for their drugs and health providers use tier ratings to make patient copays unaffordable for many .
As example ...my Cardiologist will prescribe me Inclisiran ( a PCSK9 thats 2 shots a year ) but Kaiser insists I pay the full amount ...around $6,000 a year if I want it , or stick with Repatha ( a shot every 2 wks ) which they will cover with a $1,500 a yr co pay .
For CKD patients , as you are aware , Insurers usually want LN patients to fail on Benlysta before they will consider covering Lupkynis ...Benlysta being around 1/3 rd less cost .
MD's usually try to treat their patients with the best drugs available ...wether insurers will cover them is a whole different matter .
Treatment protocols are often driven by the heads of the various departments in hospitals . So if you have a head of dept thats a fan of Dr Nissen ...dont expect a huge push to prescribe Vascepa
Kiwi