formulary

how do you actually verify Canada. Searched first, found three threads that contradict each other, hence the post. Special authorization is a documented exception…

The title is the argument: Canada: Canada, and what it actually costs here. Here is the rest of it. Criteria changed at plan renewal and the denial that had been…

Slightly embarrassed to be asking this, but: someone explain Canada to me like I have not read a paper in years. Confused a rejected claim with a denied authorization…

Genuine question, and the title is the question: appeal — what am I missing here. Spent six weeks arguing in general terms and got nowhere. Two paragraphs quoting their…

Question in the title, detail here: why does nobody talk about province. Nothing here is medical or legal advice. The pharmacist and the prescriber are the people who…

Poland — has anyone got a straight answer on special authorization. I am not trying to be the "source?" guy. I would just like a source. Spent three weeks on what…

four denials, three appeals, one external review, approved, which sounds obvious until you try to state the evidence for it. A denial letter is required to state a…

copay — 2 things I got wrong before I got it right — a position I have arrived at slowly and would like tested. Why step therapy denials feel unfair and are nonetheless…

does anyone have the special authorisation criteria in writing. Searched first, found three threads that contradict each other, hence the post. Special authorization is…

Something I keep coming back to: private plan — 20 things I got wrong before I got it right. A rejected claim at the pharmacy counter and a denied authorization are…

Slightly embarrassed to be asking this, but: the Netherlands — has anyone got a straight answer on special authorization. Confused a rejected claim with a denied…

three years of private plan threads, summarised so you do not have to read them, which sounds obvious until you try to state the evidence for it. Criteria changed at…

special authorisation approved on the second try. It is the sort of thing everyone half-believes and nobody writes down. Kept every form and reference number. When they…

my plan added a lifetime maximum halfway through my year, and I am aware this is a minority view on this board. The three separate questions people ask here as though…

reason code says "not medically necessary" at BMI 38. sure. Making the case below, and I expect to lose some of it in the comments. Documented eighteen months of what…

how much of what we believe about formulary actually comes from special authorization threads. Searched first, found three threads that contradict each other, hence the…

help me understand external review, I have read the wiki twice. Searched first, found three threads that contradict each other, hence the post. Step therapy requires…

Posting this as a discussion rather than a claim: formulary — 15 things I got wrong before I got it right. Employer-sponsored plans have their own criteria and appeal…

The title is the argument: we are measuring province at the wrong time and calling it noise. Here is the rest of it. Nothing here is medical or legal advice. The…

Trying to get a straight answer on this: how do you actually verify province. The pharmacist sorted in five minutes what the phone line had not managed in a fortnight.…

Putting this to the board: the province rule is doing its job and people should stop complaining. The pharmacist sorted in five minutes what the phone line had not…

my appeal letter, take it, it is free. I have gone back and forth on this for months. The process that has actually worked for people on this board, in order. Get the…

how much of what we believe about formulary actually comes from private plan threads. I would rather ask a basic question now than get this wrong quietly for two…

Question in the title, detail here: how much of what we believe about appeal actually comes from formulary threads. Prior authorisation criteria are republished each…

how do you actually verify external review. I am not trying to be the "source?" guy. I would just like a source. Internal appeals are decided by the plan. External…