Using outside vendors that serve as “hubs” to handle prior authorizations, or PAs, is not uncommon, but the practice occupies a murky space in the industry. A drugmaker that contracts with a hub provides a benefit to doctors by taking onerous work off their clinics’ hands, so it can function like a kickback: If you write our product instead of the other one, we’ll pay for the grunt work. What’s more, any outside vendor hired to handle PAs has an incentive to please its client by getting prescriptions pulled through. There is some motive, then, for a hub to massage the facts in order to fit
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