[Discussion] the Ontario answer is not the Alberta answer
the Ontario answer is not the Alberta answer, which sounds obvious until you try to state the evidence for it. Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more. Special authorization is a documented exception process with published criteria. Applications that…
Formulary criteria are revised, and plan renewal is a natural point at which a previously refused request may succeed without anything about the applicant changing.
compare cash prices before assuming coverage is the only path
Formulary criteria are revised, and plan renewal is a natural point at which a previously refused request may succeed without anything about the appli
ferritin_low is right that a rejected claim and a denied authorization are different animals.
a rejected claim is not the same as a denied authorization
Provincial plan, employer plan, or paying cash?
Same view — private and provincial plans are genuinely different processes with different appeal routes.
ask the pharmacy what the cash price is, it varies