Why do you guys get so happy when things are good and so mad when things are bad? Have you not figured out that it is determined, way above your head, who wins and loses? Managed Care determines who wins and loses. If you are in a state that has a high volume of the plans that cover a particular drug, you will win. If you don't you are screwed! It has very little to do with skills, intelligence. Also, if you are hit with a ton of objective at the start of 1S or 2S, even though the plans in your area do not cover the drug with said objective, they want you gone. That's how it works.