help me understand Canada, I have read the wiki twice
The title is the whole question — help me understand Canada, I have read the wiki twice — but here is why I am asking.
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.
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.
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
Corrections welcome, especially the pedantic ones. Pedantry is how this board earns its reputation.
best — the order this archive was captured in
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.
the pharmacist is often the fastest route to a definite answer
formulary decisions are provincial, so the province is the first fact
say the province or the answers will be wrong
compare cash prices before assuming coverage is the only path
Correcting myself: it was a quantity limit rather than a denial, which changes the whole process.
Provincial plan, employer plan, or paying cash?
a rejected claim is not the same as a denied authorization
Those criteria were revised at renewal, so the version quoted upthread is out of date.
I would not read one pharmacy’s cash price as the going rate. The spread is real.
That is an employer plan process, and the provincial route is different in both form and timeline.
Moved provinces and the coverage position changed completely. Same person, same history, different formulary.
- 1the pharmacist is often the fastest route to a definite answer6 comments in this branch · started by u/hair_shed_hannah
- 2Provincial plan, employer plan, or paying cash?6 comments in this branch · started by u/karim_ilunga