[Question] Denmark — has anyone got a straight answer on province
Denmark — has anyone got a straight answer on province — that is what I am asking, and I have already read the wiki twice.
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.
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.
Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.
Research-use-only material is not approved for human use and nothing here should be read as a recommendation to use it.
best — the order this archive was captured in
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.
Have you seen the special authorization criteria for your province?
formulary decisions are provincial, so the province is the first fact
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.
Has your plan renewed since the last time you applied?
A rejected claim at the pharmacy counter and a denied authorization are different events with different remedies.
Agreed — write the application against the published criteria rather than around them.
Agreed — write the application against the published criteria rather than around them.
Adding the fastest step — ask the pharmacist. They can usually check in minutes.
Yes. Approval and coverage are separate, and this board conflates them in about half its threads.
[deleted]
keep every form, every date, every reference number
keep every form, every date, every reference number
This is why every thread here needs a province in it.
A rejected claim at the pharmacy counter and a denied authorization are different events with different remedies.
Disagreeing with this line: that is an employer plan process and the provincial one differs.
Was this a denied authorization or a rejected claim?
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 denial letter names a criterion, that is your handle
Is there a quantity limit involved rather than a coverage refusal?
Have you asked the pharmacist to check?
I would not read one pharmacy’s cash price as the going rate. The spread is real.
Push back: approval by the national regulator says nothing about whether any plan will pay.
Health Canada approval is not coverage
Disagree — that is your province’s formulary position and it does not carry to another.
Plan and policy numbers redacted from the screenshot above.
What did the denial actually say?
What did the denial actually say?
diego_almeida is right that a rejected claim and a denied authorization are different animals.
special authorization forms are published, read them before applying
Cosigning on quantity limits. They stop as many people as outright denials do and get discussed far less.
a rejected claim is not the same as a denied authorization
Not convinced. A rejected claim at the counter is not a denied authorization and the next step differs.
compare cash prices before assuming coverage is the only path
National regulatory approval establishes that a product may be sold. Whether any plan pays for it is a separate decision, and public drug plans are administered provincially.
- 1A rejected claim at the pharmacy counter and a denied authorization are…11 comments in this branch · started by u/canada_coverage
- 2a denial letter names a criterion, that is your handle8 comments in this branch · started by u/draw_up_dizzy