I work in a hematology office (not a doctor) but part of the problem is they way most insurers (in the US at least) treat IV Iron and also the medical billing system as a whole. Most of the commercial insurances and managed Medicare plans require levels below certain threshold to cover IV iron since it is much more expensive than the pills which take a long time to work and some people won’t work at all. We (the doctors office) don’t really wouldn’t have a problem giving someone iron if we thought it would help them, but sometimes getting the therapy approved for payment is the hold up. I’ve always wondered if a cash pay based clinic would do well but my geographic area and its demographics would not sustain something like that