[Discussion] the formulary advice in here is 2 years out of date
the formulary advice in here is 2 years out of date — a position I have arrived at slowly and would like tested.
Numbers, in the order they matter: 2 years.
Kept every form and reference number. When they had no record of a submission, I did.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
Screenshot none of this. Read the whole thread, including the parts where I am told I am wrong.
best — the order this archive was captured in
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.
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.
Careful, that criterion was updated at renewal and the version you are quoting is superseded.
This. The special authorization form is published and reading it before applying changes the outcome.
Moved provinces and the coverage position changed completely. Same person, same history, different formulary.
Moved provinces and the coverage position changed completely.
Adding the fastest step — ask the pharmacist. They can usually check in minutes.
Adding the fastest step — ask the pharmacist.
This is why every thread here needs a province in it.
Pharmacy staff name removed. The pharmacy can stay in a pricing post.
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
Not convinced. A rejected claim at the counter is not a denied authorization and the next step differs.
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.
Was this a denied authorization or a rejected claim?
Provincial plan, employer plan, or paying cash?
Have you seen the special authorization criteria for your province?
Is there a quantity limit involved rather than a coverage refusal?
the exception drug status route exists in several provinces
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
Same view — private and provincial plans are genuinely different processes with different appeal routes.
- 1Quantity limits restrict how much may be dispensed in a period even where…8 comments in this branch · started by u/crosspost_bot_no
- 2Careful, that criterion was updated at renewal and the version you are…6 comments in this branch · started by u/kian_ekstrom