[Question] Canada — has anyone got a straight answer on special authorization
Canada — has anyone got a straight answer on special authorization. Searched first, found three threads that contradict each other, hence the post.
Kept every form and reference number. When they had no record of a submission, I did.
The pharmacist sorted in five minutes what the phone line had not managed in a fortnight.
Compared cash prices across four pharmacies before pursuing coverage and the spread was larger than I expected.
If two or three other people have done the same thing we might actually learn something. Alone it is an anecdote.
best — the order this archive was captured in
A rejected claim at the pharmacy counter and a denied authorization are different events with different remedies. The first can be an administrative or quantity issue; the second is a determination you can appeal.
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formulary decisions are provincial, so the province is the first fact
Cosigning on quantity limits. They stop as many people as outright denials do and get discussed far less.
Same view — private and provincial plans are genuinely different processes with different appeal routes.
Quantity limits restrict how much may be dispensed in a period even where coverage exists. They are a distinct barrier and require a distinct request.
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
Agreed. Province first — coverage is a provincial decision and national answers are wrong somewhere by construction.
Agreed.
Agreed — write the application against the published criteria rather than around them.
keep every form, every date, every reference number
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
hedda_aguirre is right that a rejected claim and a denied authorization are different animals.
Health Canada approval is not coverage
Agreed on keeping every form and date. When something goes wrong the paper trail is the whole case.
Small fix — that formulary position is another province’s and does not apply here.
This. The special authorization form is published and reading it before applying changes the outcome.
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.
special authorization forms are published, read them before applying
Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.
Read the special authorization criteria and wrote the application against them line by line.
Adding the fastest step — ask the pharmacist. They can usually check in minutes.
Yes. Approval and coverage are separate, and this board conflates them in about half its threads.
Have you asked the pharmacist to check?
Yes. Cash prices vary and comparing them before assuming coverage is the only route is worth doing.
- 1A rejected claim at the pharmacy counter and a denied authorization are…15 comments in this branch · started by u/spreadsheet_gremlin