[Question] Canada — has anyone got a straight answer on special authorization
Canada — has anyone got a straight answer on special authorization. Searched first, found three threads that contradict each other, hence the post. Kept every form and reference number. When they had no record of a submission, I did. The pharmacist sorted in five minutes what the phone line had not managed in a…
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.
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formulary decisions are provincial, so the province is the first fact
Cosigning on quantity limits. They stop as many people as outright denials do and get discussed far less.
Same view — private and provincial plans are genuinely different processes with different appeal routes.
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.
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
Agreed. Province first — coverage is a provincial decision and national answers are wrong somewhere by construction.
Agreed.
Agreed — write the application against the published criteria rather than around them.
keep every form, every date, every reference number
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
hedda_aguirre is right that a rejected claim and a denied authorization are different animals.
Health Canada approval is not coverage
Agreed on keeping every form and date. When something goes wrong the paper trail is the whole case.
Small fix — that formulary position is another province’s and does not apply here.
This. The special authorization form is published and reading it before applying changes the outcome.