[Discussion] the province advice in here is 3 years out of date
the province advice in here is 3 years out of date.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 that is flagged as an impression.
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.
Tell me where this is wrong. That is the useful part of posting it.
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.
Not convinced. A rejected claim at the counter is not a denied authorization and the next step differs.
Agreed on keeping every form and date. When something goes wrong the paper trail is the whole case.
Have you seen the special authorization criteria for your province?
Provincial plan, employer plan, or paying cash?
Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.
Compared cash prices across four pharmacies before pursuing coverage and the spread was larger than I expected.
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.
Province added to the title. Coverage is provincial and the thread could not be answered without it.
Those criteria were revised at renewal, so the version quoted upthread is out of date.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.
Have you asked the pharmacist to check?
- 1Special authorization is a documented exception process with published…7 comments in this branch · started by u/quiet_reader_99