[Discussion] Canada is doing more work than we give it credit for
The title is the argument: Canada is doing more work than we give it credit for. Here is the rest of it. Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more. Compared cash prices across four pharmacies before pursuing coverage and the spread was larger than I…
Is there a quantity limit involved rather than a coverage refusal?
Push back: approval by the national regulator says nothing about whether any plan will pay.
Correcting myself: it was a quantity limit rather than a denial, which changes the whole process.
formulary decisions are provincial, so the province is the first fact
Careful, that criterion was updated at renewal and the version you are quoting is superseded.
Those criteria were revised at renewal, so the version quoted upthread is out of date.
a denial letter names a criterion, that is your handle
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
Same view — private and provincial plans are genuinely different processes with different appeal routes.
Yes. Cash prices vary and comparing them before assuming coverage is the only route is worth doing.