private plan — 18 things I got wrong before I got it right
private plan — 18 things I got wrong before I got it right, which sounds obvious until you try to state the evidence for it. 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. Quantity limits…
Cash pricing, which people skip because they assume coverage is the only route.
Prices at the counter vary between pharmacies, sometimes substantially, in the same city. Members here have found spreads worth a real amount per month by ringing four places and asking for the cash price of a specific presentation.
That does not make coverage unimportant. It does mean that while an authorization is in process — which can take weeks — knowing the actual cash spread is worth half an hour of phone calls. Post what you find with the province and the month; the comparison threads here work for exactly the same reason the UK pricing tracker does.
Those criteria were revised at renewal, so the version quoted upthread is out of date.
Those criteria were revised at renewal, so the version quoted upthread is out of date.
solene_eriksen is right that a rejected claim and a denied authorization are different animals.
Correction: that is regulatory approval, not coverage. They are separate decisions by separate bodies.
Correcting myself: it was a quantity limit rather than a denial, which changes the whole process.
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.
Formulary criteria are revised, and plan renewal is a natural point at which a previously refused request may succeed without anything about the appli
This is why every thread here needs a province in it.
The pharmacist sorted in five minutes what the phone line had not managed in a fortnight.