formulary

the denial question that gets asked weekly, answered properly, and I am aware this is a minority view on this board. The process that has actually worked for people on…

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…

HSA dollars changed the real cost by a third and i nearly missed it. I have gone back and forth on this for months. Internal appeals are decided by the plan. External…

the external review process nobody tells you exists. Short post, long comment section, probably. New plan year, entirely new criteria, and the denial that had been…

step therapy is the most under-discussed thing on this board. It is the sort of thing everyone half-believes and nobody writes down. External review was the thing that…

three years of special authorization threads, summarised so you do not have to read them. Not a hot take, just something I have not seen said plainly here. Read the…

Sweden: external review, and what it actually costs here, and I am aware this is a minority view on this board. The process that has actually worked for people on this…

does formulary 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 minutes…

genuine question about private plan that I am slightly embarrassed to ask. If this has been answered properly somewhere, link me and I will delete. Compared cash prices…

denial reason codes decoded, mostly fixable paperwork. Making the case below, and I expect to lose some of it in the comments. Documented eighteen months of what had…

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

the province advice in here is 3 years out of date. It is the sort of thing everyone half-believes and nobody writes down. Hard numbers: 3 years. Anything softer than…

the appeal advice in here is 2 years out of date, which sounds obvious until you try to state the evidence for it. Pulling the figures out of the title: 2 years. All of…

US, employer plan, eleven months start to finish. The thing that finally worked was embarrassingly simple. Denials one through three were all "not medically necessary"…

Canada is the most under-discussed thing on this board — a position I have arrived at slowly and would like tested. Employer-sponsored plans have their own criteria and…

formulary — 11 things I got wrong before I got it right. Not a hot take, just something I have not seen said plainly here. Special authorization is a documented…

step therapy — how do i document failing something cheaper. I would rather ask a basic question now than get this wrong quietly for two months. Asked for the policy…

copay — what am I missing here. If this has been answered properly somewhere, link me and I will delete. A peer-to-peer conversation puts the prescribing clinician in…

Putting this at the top of the board where it belongs: private plan is not what most of this community thinks it is. The three separate questions people ask here as…

employer carve-out was in the plan document, not the summary. I have gone back and forth on this for months. Internal appeals are decided by the plan. External review…

the prior authorization question that gets asked weekly, answered properly, and I am aware this is a minority view on this board. Internal appeals are decided by the…

Question in the title, detail here: help me understand step therapy, I have read the wiki twice. New plan year, entirely new criteria, and the denial that had been…

Posting this as a discussion rather than a claim: the province thing finally clicked for me and I want to write it down. How to write a special authorization request…

the formulary advice in here is 2 years out of date — a position I have arrived at slowly and would like tested. Numbers, in the order they matter: 2 years. Kept every…

Putting this at the top of the board where it belongs: external review is not what most of this community thinks it is. Internal appeals are decided by the plan.…