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September 23/30, 1998

Physician Recommendations vs Insurance Coverage for Growth Hormone—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(12):1052-1054. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-12-jbk0923

In Reply.—Dr Berman asks about the breakdown of general coverage policies (always, sometimes, or never cover GH therapy if prescribed by an authorized physician) for BC/BS plans and private insurers. We refer Berman to Tables 1 and 2 of our article, in which these data are shown.

We agree with Berman that there may often be honest differences of opinion among informed experts about the value of new treatments. As stated in our article, our study cannot establish whether current practices are right or wrong. However, the wide gap between the recommendations of physicians and the approvals of insurers in the cases under study underscores a potentially far-reaching problem in the US health care system. We believe that insurers often make very careful and fair analyses of information in arriving at coverage decisions.1 Nevertheless, greater dialogue between insurers and physicians is needed to minimize discrepancies in coverage and to provide optimal patient care.