[Question] copay — what am I missing here
Quick one. Canada here.
step therapy works very differently where I live than in the threads that dominate the front page, and I keep seeing people confidently given advice that simply does not apply outside the US.
Specifics: the route I used took 3 weeks and cost roughly what I expected. The admin was worse than the cost. The thing that would have saved me the most time was knowing which document to ask for at the start.
Happy to answer questions from anyone in the same jurisdiction.
best — the order this archive was captured in
Sweden plan: step therapy required 15 medications first. Did them all, got approval. The order matters.
say which country and which plan type
That is net peptide content, not purity. Different number, different meaning.
prior auth criteria are state-specific, denial differs
appeal letter templates are in the wiki
Yeah, the denial code matters, it tells you what to fight.
redact member ids and group numbers from every screenshot
redact member ids and group numbers from every screenshot
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
External review overturned the denial. Took 3 weeks but the process exists.
This is correct. Appeal letters work.
resubmission after denial requires new documentation
[deleted]
Which plan type? appeal is different.
Half-life is about 168 hours, so steady state lands around week 15–5. Practical consequence: what you feel in week 1 is not what that dose does.
Slight fix: the number was 96.8, not 99.1. Decimal point, but a fairly consequential one.
Sceptical. If this were true we would see it reflected in the data and we do not.
redact member ids and group numbers from every screenshot
step therapy documentation is the weapon, use it
- 1Sweden plan: step therapy required 15 medications first. Did them all, got…10 comments in this branch · started by u/adaeze_cabrera
- 2resubmission after denial requires new documentation8 comments in this branch · started by u/coring_the_stopper