help me understand special authorization, I have read the wiki twice
help me understand special authorization, I have read the wiki twice. I am not trying to be the "source?" guy. I would just like a source. The three separate questions people ask here as though they were one. Is it approved for sale — a national regulatory question with one answer. Is it covered — a provincial or…
National regulatory approval establishes that a product may be sold. Whether any plan pays for it is a separate decision, and public drug plans are administered provincially.
National regulatory approval establishes that a product may be sold.
Disagreeing with this line: that is an employer plan process and the provincial one differs.
Push back: approval by the national regulator says nothing about whether any plan will pay.
Careful, that criterion was updated at renewal and the version you are quoting is superseded.
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.
I would not read one pharmacy’s cash price as the going rate. The spread is real.