unpopular opinion: formulary is massively overrated
Trying to settle this properly because the thread from last year went in circles.
The claim: formulary matters. The counter-claim: it is measurement error. Both sides have been asserting it confidently for about 11 months without either producing anything.
What would actually settle it is 7 people measuring the same thing the same way. I have started; my numbers are below. They lean one way but not strongly enough for me to declare victory.
If you have data, post the data. If you have an opinion, flair it as an opinion.
best — the order this archive was captured in
I am going to push back on this slightly.
I am going to push back on this slightly.
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
step therapy documentation is the weapon, use it
Ireland plan: step therapy required 12 medications first. Did them all, got approval. The order matters.
This is an urgent-care question wearing a forum question's clothes. Please contact a clinician rather than waiting for replies.
Disagree. What you are describing is consistent with copay, not with what you concluded.
Strongly agree. Step therapy is predictable if you have the criteria.
resubmission after denial requires new documentation
This is an urgent-care question wearing a forum question's clothes.
Adding to this: appeal is doing more work than the comment implies.
resubmission after denial requires new documentation
Which plan type? step therapy is different.
Which plan type?
Disagree on that part. 98.0% and 98.1% on the same vial is normal.
denial reason codes matter, ask for the actual code
Disagree but this is the good kind of wrong — it is specific enough to be checked.
Disagree but this is the good kind of wrong — it is specific enough to be checked.
Yes, exactly this, and it is the bit that took me 66 weeks to accept.
Crossposting this to c/cryptopay because the people who need it are not reading this community.
formulary exclusions are negotiable sometimes
resubmission after denial requires new documentation
No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.
You have restated the marketing copy. What is the actual substance here.
Strongly agree. Step therapy is predictable if you have the criteria.
Inter-lab variance on this kind of assay is routinely 1–2 points. Different column, different gradient, different integration.
This is correct. Appeal letters work.
- 1I am going to push back on this slightly.11 comments in this branch · started by u/hassan_chowdhury
- 2Crossposting this to c/cryptopay because the people who need it are not…6 comments in this branch · started by u/kasper_cabrera