formulary vs step therapy — genuinely asking which matters more
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, reflux, 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 15 months. My ApoB 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.
best — the order this archive was captured in
Yeah, the denial code matters, it tells you what to fight.
Did you get step therapy or outright denial?
Tracking number removed. It identifies both ends of a shipment.
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Small correction: the trial was 6 weeks, not 14. Does not change your point but people will quote it.
That is net peptide content, not purity. Different number, different meaning.
Yeah, the denial code matters, it tells you what to fight.
The confident tone is doing a lot of work that the evidence is not.
step therapy documentation is the weapon, use it
step therapy documentation is the weapon, use it
Disagree on that part. 93.7% and 99.3% on the same vial is normal.
Which plan type? denial is different.
Yeah, the denial code matters, it tells you what to fight.
formulary exclusions are negotiable sometimes
formulary exclusions are negotiable sometimes
Adding to this: formulary is doing more work than the comment implies.
prior auth criteria are state-specific, step therapy differs
prior auth criteria are state-specific, step therapy differs
Yes, exactly this, and it is the bit that took me 6 weeks to accept.
denial reason codes matter, ask for the actual code
Which plan type? appeal is different.
Strongly agree. Step therapy is predictable if you have the criteria.
Copay was formulary for the copay then another 6% of the total. Read the actual plan document.
Sceptical. If this were true we would see it reflected in the data and we do not.
formulary exclusions are negotiable sometimes
This is correct. Appeal letters work.
This is correct.
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
external review is the appeal after insurance says no
the carve-out clause varies by employer
- 1The confident tone is doing a lot of work that the evidence is not.14 comments in this branch · started by u/ignacio_vanhecke
- 2Tracking number removed. It identifies both ends of a shipment.4 comments in this branch · started by u/prior_auth_pain