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[1] The practice worked its way into shamanistic rituals

Among other things, the report found that providers incur additional costs associated with delivering clotting factor that are not separately reimbursed by Medicare. Specifically, the report cited delivery costs generated in inventory management, specialized refrigerated storage, shipping, and the provision of ancillary supplies such as needles, syringes, and tourniquets to patients that were not accounted for by Medicare payment for the clotting factor product alone