TY - JOUR
T1 - Full coverage, partial coverage, no coverage for growth hormone treatment
T2 - Madison insurance choices as a microcosm
AU - Fost, N.
AU - Fleming, L.
AU - Brock, D.
AU - Kaufman, M.
AU - MacGillivray, M.
AU - Sandberg, D.
AU - Fox, J.
AU - Rosenfeld, R.
AU - Lipman, T.
AU - Pauly, M.
AU - Allen, D. B.
PY - 2001
Y1 - 2001
N2 - HMOs differ in their policies on reimbursement for growth hormone prescriptions. Even with one city, policies range from full reimbursement, to 50% co-pay, to no reimbursement. Presently, decisions are made on a case by case basis, relying on a wide range of criteria. These include FDA approval for the indication, opinions by clinical experts, literature review of likely benefit, definition of disease, cost, availability of alternatives, concerns about adverse selection, whether employers are willing to purchase coverage, whether the treatment is investigational, and whether it is a "medical necessity" - although the definition of that term is unclear.
AB - HMOs differ in their policies on reimbursement for growth hormone prescriptions. Even with one city, policies range from full reimbursement, to 50% co-pay, to no reimbursement. Presently, decisions are made on a case by case basis, relying on a wide range of criteria. These include FDA approval for the indication, opinions by clinical experts, literature review of likely benefit, definition of disease, cost, availability of alternatives, concerns about adverse selection, whether employers are willing to purchase coverage, whether the treatment is investigational, and whether it is a "medical necessity" - although the definition of that term is unclear.
UR - http://www.scopus.com/inward/record.url?scp=0034890451&partnerID=8YFLogxK
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M3 - Article
AN - SCOPUS:0034890451
SN - 1051-2144
VL - 11
SP - 37S-41S
JO - Endocrinologist
JF - Endocrinologist
IS - 4 SUPPL.
ER -