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The survey found about 1 in 4 users had to pay the full cost of their medications
Endocr Connect 10(7):R200R212

Why the titration schedule exists The gradual dose escalation is not arbitrary

Because the model was voluntary for Part D plan sponsors, CMS designed financial incentives to encourage plan participation
Di Cairano ES, Davalli AM, Perego L, et al

doi: 10.1007/s001250050348 61 SchenkerSDawberNHSchmidR