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copay: what the trials say vs what this community says

Template Sourced ×4 The Quiet One ×3 Clean Column ×3

Right, the formulary question again, but with numbers this time.

I have 11 data points over 36 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign.

The thing I would flag for anyone new: the effect I am describing showed up at week 33, not week 82. People give up long before the interesting part.

Interested in whether this matches other people's logs or whether I am an outlier.

3,865 up / 205 down95% upvoted42 commentsid d1vfr515 Sep 2024

42 comments

12 in this archive, depth 5

best — the order this archive was captured in

u/marta_marchand727 points·1 year ago

Disagree but this is the good kind of wrong — it is specific enough to be checked.

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u/janoshik_junkieindependent tester302 points·1 year ago

external review is the appeal after insurance says no

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u/hamza_weiss-22 points·1 year ago

copay is separate from coverage

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u/elin_lindqvist1 point·1 year ago·edited

No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.

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u/ferran_dahlberg1 point·1 year ago·edited

the carve-out clause varies by employer

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u/honest_syringe19OP1 point·1 year ago

Small correction: the trial was 13 weeks, not 24. Does not change your point but people will quote it.

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u/formulary_fighterMOD384 points·1 year ago

Flair changed to match the content. Read the sidebar before posting next time and we are square.

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u/coring_the_stopper98 points·1 year ago

say which country and which plan type

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u/elin_lindqvist60 points·1 year ago

That is net peptide content, not purity. Different number, different meaning.

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u/adaeze_cabrera124 points·1 year ago

appeal letter templates are in the wiki

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u/fabio_kuipers91 points·1 year ago

copay is separate from coverage

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u/adaeze_cabrera330 points·1 year ago·edited

Strongly agree. Step therapy is predictable if you have the criteria.

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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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