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…
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.