New Zealand: Canada, and what it actually costs here
New Zealand: Canada, and what it actually costs here. Not a hot take, just something I have not seen said plainly here. Special authorization is a documented exception process with published criteria. Applications that answer those criteria explicitly, point by point, fare better than general clinical narratives. How…
Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.
What did the denial actually say?
Have you asked the pharmacist to check?
Have you seen the special authorization criteria for your province?
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.
Moved provinces and the coverage position changed completely. Same person, same history, different formulary.
Disagree — that is your province’s formulary position and it does not carry to another.
the same product can be covered in one province and not the next
a rejected claim is not the same as a denied authorization
Health Canada approval is not coverage
Push back: approval by the national regulator says nothing about whether any plan will pay.
Yes. Approval and coverage are separate, and this board conflates them in about half its threads.