Yes, unfortunately HMO's are the gatekeepers to specialized care, and I for one can't afford the rising cost of PPO's. I do have a gastro that I get referrals to see, unfortunately he isn't a prescribing lotronex doctor and keeps telling me it's because the GlaxcoSmithklein rep hasn't been to his office. When I told him that I found a prescribing doctor(found on the Doctors for Lotronex web site in my state) he began questioning me about how this doctor was able to become a prescribing lotronex phys. When I asked him if he'd like this doctors name and number to call to discuss this he outright declined. I aslo explanied to him that he can call Glaxo and sign up. He is going to wait for the rep to reschedule. This is so nuts. Something tells me he could be doing so much more to get his patients back on lotronex. He's the one who introduced me to lotronex a few years ago. I have lost faith in him and my PCP who also doesn't seem to know anything about lotronex. I explained to both of them that Walgreens pharmacy is now dispensing lotronex and all I need is a participating doctor.