formulary

how much of what we believe about appeal actually comes from step therapy threads. Searched first, found three threads that contradict each other, hence the post. Asked…

Proposal, not a decision: the Canada rule is doing its job and people should stop complaining. National regulatory approval establishes that a product may be sold.…

The title is the whole question — does prior authorization actually matter or is it forum lore at this point — but here is why I am asking. New plan year, entirely new…

Genuine question, and the title is the question: how do you actually verify formulary. Documented eighteen months of what had been tried in a one-page table. That table…

three years of denial threads, summarised so you do not have to read them. It is the sort of thing everyone half-believes and nobody writes down. Asked for the policy…

unpopular opinion: most of what gets said here about appeal is guesswork. Not a hot take, just something I have not seen said plainly here. External review was the…

proposal — a flair for private plan posts. Disagreement welcome, but bring a concrete alternative wording. Quantity limits restrict how much may be dispensed in a…

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…

Something I keep coming back to: unpopular opinion: most of what gets said here about province is guesswork. A rejected claim at the pharmacy counter and a denied…

Asking properly rather than in a comment on somebody else’s thread: how much of what we believe about private plan actually comes from special authorization threads.…

Asking properly rather than in a comment on somebody else’s thread: special authorization — what am I missing here. The pharmacist sorted in five minutes what the phone…

the UK — has anyone got a straight answer on formulary, and I want the answer with the reasoning attached rather than just the conclusion. Kept a log with every date,…

the appeal advice in here is 3 years out of date. It is the sort of thing everyone half-believes and nobody writes down. The numbers the title promised, since a…

The title is the argument: three years of prior authorization threads, summarised so you do not have to read them. Here is the rest of it. Prior authorisation criteria…

Question in the title, detail here: how much of what we believe about prior authorization actually comes from appeal threads. A denial letter is required to state a…

someone explain special authorization to me like I have not read a paper in years, and I want the answer with the reasoning attached rather than just the conclusion.…

three years of step therapy threads, summarised so you do not have to read them. It is the sort of thing everyone half-believes and nobody writes down. External review…

prior authorization — 22 things I got wrong before I got it right, and I am aware this is a minority view on this board. Kept a log with every date, name of department…

the Netherlands: private plan, and what it actually costs here. It is the sort of thing everyone half-believes and nobody writes down. Read the special authorization…

does external review actually matter or is it forum lore at this point — that is what I am asking, and I have already read the wiki twice. Peer-to-peer took fifteen…

we are measuring appeal at the wrong time and calling it noise — a position I have arrived at slowly and would like tested. Employer-sponsored plans may be regulated…

the formulary thing finally clicked for me and I want to write it down, which sounds obvious until you try to state the evidence for it. A denial letter is required to…

the step therapy rule is doing its job and people should stop complaining — posting the reasoning in public because a policy you cannot inspect is just a preference.…

Thinking out loud about this: special authorization is doing more work than we give it credit for. Cash pricing, which people skip because they assume coverage is the…

private plan — 18 things I got wrong before I got it right, which sounds obvious until you try to state the evidence for it. National regulatory approval establishes…