The sales force was seeing its best results with pain management physicians who saw few cancer patients, such as Gavin Awerbuch, Paul Madison, and Xiulu Ruan. Meanwhile, nearly all insurers refused to pay for Subsys without a cancer diagnosis, because the medication was indicated for breakthrough cancer pain and no other condition. While doctors were permitted to write Subsys for anyone, that didn’t mean insurers had to cover it. And Insys needed health plans to pay; the drug was so expensive that few patients shouldered the cost themselves. Insurers would sometimes make exceptions and
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