how much of what we believe about formulary actually comes from private plan threads
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 months.
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.
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.
Please do not ask me what dose you should be on. I genuinely do not know and neither does anyone else here.
best — the order this archive was captured in
Pharmacy staff name removed. The pharmacy can stay in a pricing post.
Was this a denied authorization or a rejected claim?
ask the pharmacy what the cash price is, it varies
the same product can be covered in one province and not the next
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Disagree — that is your province’s formulary position and it does not carry to another.
Provincial plan, employer plan, or paying cash?
a denial letter names a criterion, that is your handle
Correction: that is regulatory approval, not coverage. They are separate decisions by separate bodies.
That is an employer plan process, and the provincial route is different in both form and timeline.
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.
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
say the province or the answers will be wrong
- 1Pharmacy staff name removed. The pharmacy can stay in a pricing post.10 comments in this branch · started by u/formulary_fighter