Topic: Why is health insurance in the USA able to deny what a physician order

Why is health insurance in the USA able to deny what a physician orders for treatment?

Re: Why is health insurance in the USA able to deny what a physician order

I was recently put on a new treatment regimen. I looked up the drug and there are very specific procedures spelled out for using the drug, based on research, the approval process and officially approved by FDA. The procedure spells out what more conventional treatment should be tried first, Categorizes patients based on past treatment and failures, and spells out when the drug can be used stand alone or in combination with another treatment. If the treatment request is denied, the physician can quickly make an appeal and point out any special circumstances that warrant a minor deviation from the prescribing protocol.

As an example, there are drugs being extensively advertised on TV to treat plaque psoriasis. These drugs were originally developed to treat refractory (difficult to treat successfully) arthritis, but found to also be helpful for psoriasis. This drug costs over $2000 per month. You can be sure that insurance is going to require treatment with cheaper more conventional therapy before approving use of one of these drugs.