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c/insurancefights·submitted 2 years ago by u/marta_vanhecke

formulary is the most under-discussed thing in c/cagrilintide

Discussionbranch of 4 comments

Posting this because I searched for it and got nothing useful. Setup: 10mg, week 62, injection-site soreness present but not ruining anything. I changed exactly one variable — appeal — and tracked it for 22 weeks. Result: a difference, but a small one, and well inside what I would call noise if someone else posted…

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4 comments, started 2 years ago

u/ferritin_low14 points·2 years ago

Yeah, the denial code matters, it tells you what to fight.

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u/whois_wanda8 points·2 years ago

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

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u/vito_beaulieu5 points·2 years ago

What was the denial code?

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u/marta_vanheckeOP3 points·2 years ago

appeal letter templates are in the wiki

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About c/insurancefights

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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