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formulary: the version I wish someone had shown me in week 1

Question Long Haul ×7 Cold Box ×3

step therapy. That is the whole post, but I will justify it.

Everything else people worry about in c/dosinglogs is downstream of it. Titration speed, early fullness, the endless dose arguments — most of it resolves if you sort step therapy out first, and almost nobody does.

I say this having got it wrong for 17 months. My eGFR was the thing that eventually made me pay attention, which is a stupid way to learn a lesson that was in the sidebar the whole time.

2,017 up / 53 down97% upvoted23 commentsid 1g6o0k16 Mar 2026

23 comments

8 in this archive, depth 3

best — the order this archive was captured in

u/hugo_pires112 points·4 months ago

Crossposting this to c/cagrilintide because the people who need it are not reading this community.

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u/formulary_fighterMOD80 points·4 months ago

Removed a chain here. The rule is one line long and it is not negotiable.

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u/ireland_drugs_payOP47 points·4 months ago

Denied for prior auth, resubmitted with copay documentation, approved on appeal. The criteria exist, you just have to meet them.

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u/milan_wikstrom70 points·4 months ago

say which country and which plan type

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u/greta_chukwu0 points·4 months ago

Not convinced. The evidence does not support that reading.

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u/milan_wikstrom1 point·4 months ago

redact member ids and group numbers from every screenshot

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u/ireland_drugs_payOP38 points·4 months ago

This is correct. Appeal letters work.

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u/niels_salinas103 points·4 months ago

This is correct. Appeal letters work.

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About c/insurancefights

The paperwork war. Prior-authorisation criteria, denial reason codes, step-therapy documentation, external review, employer carve-outs, and the appeal letter templates the community has iterated on for three years. Mostly US-shaped but the tactics generalise.

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Dec 2023created
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