Germany: private plan, and what it actually costs here
Thinking out loud about this: Germany: private plan, and what it actually costs here.
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.
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.
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.
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
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.
Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
That is an employer plan process, and the provincial route is different in both form and timeline.
ask the pharmacy what the cash price is, it varies
say the province or the answers will be wrong
Have you seen the special authorization criteria for your province?
Is there a quantity limit involved rather than a coverage refusal?
Was this a denied authorization or a rejected claim?
Kept every form and reference number. When they had no record of a submission, I did.
Agreed on keeping every form and date. When something goes wrong the paper trail is the whole case.
private plans and provincial plans are different fights entirely
Left up. It distinguishes a rejected claim from a denied authorization, which most posts here do not.
- 1Confused a rejected claim with a denied authorization for a month and…12 comments in this branch · started by u/controversial_only