[Meta] proposal — a flair for special authorization posts
proposal — a flair for special authorization posts. Nothing about this affects the ranking maths, before anyone asks.
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.
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.
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.
If two or three other people have done the same thing we might actually learn something. Alone it is an anecdote.
best — the order this archive was captured in
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.
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.
I would not read one pharmacy’s cash price as the going rate. The spread is real.
I would not read one pharmacy’s cash price as the going rate.
Disagreeing with this line: that is an employer plan process and the provincial one differs.
Spent three weeks on what turned out to be a quantity limit rather than a coverage question.
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
a denial letter names a criterion, that is your handle
Correction: that is regulatory approval, not coverage. They are separate decisions by separate bodies.
Correcting myself: it was a quantity limit rather than a denial, which changes the whole process.
say the province or the answers will be wrong
quantity limits are as common a barrier as coverage itself
- 1Spent three weeks on what turned out to be a quantity limit rather than a…7 comments in this branch · started by u/careful_gradient32