the formulary question that gets asked weekly, answered properly
the formulary question that gets asked weekly, answered properly. Change my mind, genuinely — I have no stake in being right about this. Cash pricing, which people skip because they assume coverage is the only route. Prices at the counter vary between pharmacies, sometimes substantially, in the same city. Members…
Left up. It distinguishes a rejected claim from a denied authorization, which most posts here do not.
Formulary criteria are revised, and plan renewal is a natural point at which a previously refused request may succeed without anything about the applicant changing.
Have you asked the pharmacist to check?
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
Cosigning on quantity limits. They stop as many people as outright denials do and get discussed far less.
Spent three weeks on what turned out to be a quantity limit rather than a coverage question.