Gurrieri began learning something from just about every phone call, offering Insys a window into how coverage decisions were being made. Most insurers, she now saw firsthand, required a diagnosis of breakthrough cancer pain for approval, which disqualified the majority of Subsys patients immediately. But it was worse than that. Insurance plans would typically only agree to pay if the patient had already tried Actiq, the generic TIRF, without success. In fact, plans often required multiple “tried and failed” medications, including opioids from outside the TIRF class, before they would cover
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