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c/glp1canada·submitted 8 months ago by u/lipid_panel_larry

Ireland: Canada, and what it actually costs here

Pricingbranch of 7 comments

Ireland: Canada, and what it actually costs here — a position I have arrived at slowly and would like tested. The pharmacist sorted in five minutes what the phone line had not managed in a fortnight. Kept every form and reference number. When they had no record of a submission, I did. Criteria changed at plan renewal…

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7 comments, started 8 months ago
u/canada_coverage68 points·8 months ago

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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u/omar_eriksen80 points·8 months ago

That is an employer plan process, and the provincial route is different in both form and timeline.

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u/lipid_panel_larryOPbloodwork-21 points·8 months ago·edited

That is an employer plan process, and the provincial route is different in both form and timeline.

omar_eriksen is right that a rejected claim and a denied authorization are different animals.

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u/ahmed_abubakar66 points·8 months ago

Moved provinces and the coverage position changed completely. Same person, same history, different formulary.

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u/draw_up_dizzy90 points·8 months ago

Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.

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u/diego_almeida19 points·8 months ago

the exception drug status route exists in several provinces

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u/camila_mensa34 points·8 months ago

This. The special authorization form is published and reading it before applying changes the outcome.

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Canadian access: provincial formulary differences, private plan coverage, the special-authorisation process, cross-border pricing arbitrage and why the Ontario answer is not the Alberta answer.

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