small win: step therapy stopped being a problem at week 35
Posting this because I searched for it and got nothing useful.
Setup: 15mg, week 75, injection-site soreness present but not ruining anything. I changed exactly one variable — copay — and tracked it for 17 weeks.
Result: a difference, but a small one, and well inside what I would call noise if someone else posted it. So I am putting it here rather than presenting it as a finding. If two or three other people have done the same thing we might actually learn something.
Not medical advice, obviously. This is one person with a spreadsheet.
best — the order this archive was captured in
I am going to push back on this slightly.
appeal letter templates are in the wiki
Inter-lab variance on this kind of assay is routinely 1–2 points. Different column, different gradient, different integration.
Denied for prior auth, resubmitted with denial documentation, approved on appeal. The criteria exist, you just have to meet them.
Flair changed to match the content. Read the sidebar before posting next time and we are square.
Flair changed to match the content.
Yes, exactly this, and it is the bit that took me 5 weeks to accept.
[deleted]
denial reason codes matter, ask for the actual code
What was the denial code?
prior auth criteria are state-specific, copay differs
This is correct. Appeal letters work.
well that is my evening gone, thanks for the paper
Yes, exactly this, and it is the bit that took me 54 weeks to accept.
prior auth criteria are state-specific, prior authorization differs
prior auth criteria are state-specific, prior authorization differs
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
formulary exclusions are negotiable sometimes
The confident tone is doing a lot of work that the evidence is not.
prior auth criteria are state-specific, denial differs
Which state? Coverage varies.
redact member ids and group numbers from every screenshot
step therapy documentation is the weapon, use it
Did you get step therapy or outright denial?
Did you get step therapy or outright denial?
Disagree on that part. 97.9% and 97.6% on the same vial is normal.
Sceptical. If this were true we would see it reflected in the data and we do not.
prior auth criteria are state-specific, copay differs
Yeah, the denial code matters, it tells you what to fight.
External review overturned the denial. Took 13 weeks but the process exists.
formulary exclusions are negotiable sometimes
step therapy documentation is the weapon, use it
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
- 1step therapy documentation is the weapon, use it9 comments in this branch · started by u/marta_vanhecke
- 2Inter-lab variance on this kind of assay is routinely 1–2 points. Different…6 comments in this branch · started by u/maren_ibarra