Ireland: Canada, and what it actually costs here
Ireland: Canada, and what it actually costs here — a position I have arrived at slowly and would like tested.
The pharmacist sorted in five minutes what the phone line had not managed in a fortnight.
Kept every form and reference number. When they had no record of a submission, I did.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
Not medical advice, obviously, and nothing here is approved for human use. One person with a spreadsheet.
best — the order this archive was captured in
A rejected claim at the pharmacy counter and a denied authorization are different events with different remedies. The first can be an administrative or quantity issue; the second is a determination you can appeal.
That is an employer plan process, and the provincial route is different in both form and timeline.
That is an employer plan process, and the provincial route is different in both form and timeline.
omar_eriksen is right that a rejected claim and a denied authorization are different animals.
Moved provinces and the coverage position changed completely. Same person, same history, different formulary.
Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.
the exception drug status route exists in several provinces
This. The special authorization form is published and reading it before applying changes the outcome.
Agreed. Province first — coverage is a provincial decision and national answers are wrong somewhere by construction.
Left up. It distinguishes a rejected claim from a denied authorization, which most posts here do not.
Have you seen the special authorization criteria for your province?
Which province?
Those criteria were revised at renewal, so the version quoted upthread is out of date.
Careful, that criterion was updated at renewal and the version you are quoting is superseded.
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.
Quantity limits restrict how much may be dispensed in a period even where coverage exists. They are a distinct barrier and require a distinct request.
Provincial plan, employer plan, or paying cash?
ask the pharmacy what the cash price is, it varies
Provincial plan, employer plan, or paying cash?
This is why every thread here needs a province in it.
Compared cash prices across four pharmacies before pursuing coverage and the spread was larger than I expected.
- 1A rejected claim at the pharmacy counter and a denied authorization are…7 comments in this branch · started by u/canada_coverage
- 2Agreed. Province first — coverage is a provincial decision and national…6 comments in this branch · started by u/marit_coelho