[Question] Canada — what am I missing here
Question in the title, detail here: Canada — what am I missing here.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
The three separate questions people ask here as though they were one.
Is it approved for sale — a national regulatory question with one answer. Is it covered — a provincial or private-plan question with many answers. Can I actually get this quantity dispensed — a quantity-limit question that is separate from coverage and stops as many people.
Say which of the three you are asking and name your province and plan type. Threads that do this get answered in two replies; threads that do not generate a page of people talking past each other, all of them correct about somewhere else.
Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
Ask me anything specific. Anything general I will probably get wrong.
best — the order this archive was captured in
Pharmacy staff name removed. The pharmacy can stay in a pricing post.
Have you asked the pharmacist to check?
The pharmacist sorted in five minutes what the phone line had not managed in a fortnight.
special authorization forms are published, read them before applying
employer plans have their own criteria and their own appeals
Pharmacy staff name removed.
This is why every thread here needs a province in it.
Kept every form and reference number. When they had no record of a submission, I did.
Small fix — that formulary position is another province’s and does not apply here.
say the province or the answers will be wrong
Nothing here is medical or legal advice. The pharmacist and the prescriber are the people who can act, and both are faster than a forum.
Agreed on keeping every form and date. When something goes wrong the paper trail is the whole case.
National regulatory approval establishes that a product may be sold. Whether any plan pays for it is a separate decision, and public drug plans are administered provincially.
Was this a denied authorization or a rejected claim?
Moved provinces and the coverage position changed completely. Same person, same history, different formulary.
Spent three weeks on what turned out to be a quantity limit rather than a coverage question.
Correction: that is regulatory approval, not coverage. They are separate decisions by separate bodies.
Those criteria were revised at renewal, so the version quoted upthread is out of date.
- 1Pharmacy staff name removed. The pharmacy can stay in a pricing post.15 comments in this branch · started by u/formulary_fighter