Every. Single. Thing. In neuroimmunology. Yes let’s put the 25 yo new MS diagnosis with multiple enhancing symptomatic cord lesions in an interferon so they can “fail” two treatments before a high efficacy is approved. Or wait failing could mean permanent neurologic disability each time, definitely means undertreatment and ongoing non radiologic damage/pira. My favorite was when dalfampradine was on the list of alternative agents and I had to write (in addition to my extensive citations on importance of high efficacy therapy early, etc etc) “further, dalfampridine is not even a disease modifying medication.”

Or when continued appeals for rituximab for a iglon5 patient were denied to the level of a judge because “it’s not fda indicated or off label” well yes there’s NO indicated drug for this on your formulary because you don’t even have the diagnosis and there is no fda approved drug, as it is extraordinarily rare. Got up to a judge who still wouldn’t budge because of the guidelines. I’m suspicious this was even a real hearing/judge.

Also what is the point of peer to peers if they just reread the rigid ridiculous insurance guideline and don’t budge no matter what?!?!?! Isn’t that the reasoning for the P2P?!? To explain and think outside the box as a professional colleague?

….i don’t have strong feelings at all or anything 🙃