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Biotech / Medical : IDPH--Positive preliminary results for pivotal trial of ID -- Ignore unavailable to you. Want to Upgrade?

To: Scott who wrote (1426)	1/15/1998 8:56:00 PM
From: Pseudo Biologist	Respond to of 1762

Scott, thanks much, this is great information, and the examples are helpful. Given the buzz in the popular press and other places about the potential tightness under managed care, one cannot help but wonder how terms like "relatively mainstream" and "reasonably related" may be interpreted by those who approve payment, especially for a brand-new drug. Given Rituxan's reasonable cost (compared to rounds of chemotherapy) and fairly mild side effect profile, one would hope reimbursement would be a slam dunk for many off-label uses. However, I rather don't assume those things, and ask around instead. I brought up the issue in the context of your post, because it "sounded" (how do typed words sound?) as if you could have an interesting and informed take on the matter. Thanks again, PB

To: Scott who wrote (1426)	1/18/1998 9:41:00 PM
From: Roger Cranwill	Respond to of 1762

Scott-As a pharmacist, I can tell you exactly what insurance companies are interested in-the most "bang" for the lowest "buck". When we bill online for medications, the diagnosis is never asked-only does the drug in question reside in that insurance company's specific formulary. If it doesn't (another way to read that is "too expensive" for the desired patient outcome), then the doctor has to fill out paperwork getting special authorization-its normally given, but the imposition of additional paperwork is incentive for staying within the scope of the formulary. To summarize, the real question is if the drug is in the insurance company's formulary. Period. Roger