Denmark: step therapy, and what it actually costs here
Been lurking in c/cryptopay for about 13 months and finally have something worth posting.
Short version: week 16, 0.25mg, and step therapy is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 19 threads, and the answers split roughly down the middle.
What I actually want to know is whether the people saying it does not matter have measured it, or whether it is just repeated confidently. Happy to be told I am overthinking this — I probably am — but I would rather overthink it now than at week 10.
best — the order this archive was captured in
appeal letter templates are in the wiki
Canada plan: step therapy required 24 medications first. Did them all, got approval. The order matters.
External review overturned the denial. Took 22 weeks but the process exists.
external review is the appeal after insurance says no
Disagree. What you are describing is consistent with prior authorization, not with what you concluded.
the carve-out clause varies by employer
the carve-out clause varies by employer
Yes, exactly this, and it is the bit that took me 48 weeks to accept.
New Zealand plan: step therapy required 6 medications first. Did them all, got approval. The order matters.
Copay was step therapy for the copay then another 22% of the total. Read the actual plan document.
Copay was step therapy for the copay then another 22% of the total.
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
Retitled to remove editorialising. Put the evidence in the body.
do not suggest misrepresenting a diagnosis, that is fraud
This is correct. Appeal letters work.
Which state? Coverage varies.
external review is the appeal after insurance says no
Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.
Strongly agree. Step therapy is predictable if you have the criteria.
appeal letter templates are in the wiki
Slight fix: the number was 98.9, not 99.0. Decimal point, but a fairly consequential one.
Did you get step therapy or outright denial?
step therapy documentation is the weapon, use it
prior auth criteria are state-specific, prior authorization differs
- 1Copay was step therapy for the copay then another 22% of the total. Read the…15 comments in this branch · started by u/hedda_aguirre
- 2Canada plan: step therapy required 24 medications first. Did them all, got…4 comments in this branch · started by u/liv_vukovic