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Many doctors tell a similar story. A patient is responding well to a particular drug or treatment, and it’s inexpensive. Then the payer stops coverage for it, forcing the doctor to try new options, which don’t work as well.
The patient becomes stressed as one payer-approved drug after another doesn’t work, and costs rise as doctor and emergency department visits increase. Maybe it ends with the patient in the hospital. The patient isn’t as healthy, the doctor has invested more time and effort, and the payer’s costs are higher than if they had kept paying for the original treatment.
The patient, the doctor, and the payer all lose. Yet doctors say this scenario is not uncommon.
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By Todd Shryock / Medical Economics