Imagine spending eight years after high school studying for your dream career. You apply to every medical school you can think of. If you don’t get into a cheaper state school, you apply to more expensive private medical schools. Some aspiring physicians even apply to schools in other countries. When you finally graduate you must then apply for graduate medical education (GME) training programs, which are required before you can practice medicine in all 50 states.
In 2018 the Centers for Medicare and Medicaid Services (CMS) suddenly removed Auryxia (ferric citrate) from the Medicare Part D drug formulary and began to require prior authorization for the few indications it would reimburse. CMS gave little information about the reversal but apparently made the decision because it views ferric citrate at a mineral product, like dietary supplements such as Vitamin C. Dietary supplements are not covered by Medicare except in a few cases.