three years of private plan threads, summarised so you do not have to read them
three years of private plan threads, summarised so you do not have to read them, 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.
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 private-plan question with many answers. Can I actually get this quantity dispensed — a quantity-limit question that is separate from coverage and stops as many people.
Say which of the three you are asking and name your province and plan type. Threads that do this get answered in two replies; threads that do not generate a page of people talking past each other, all of them correct about somewhere else.
Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
If somebody has the same thing measured a different way, post it next to mine and we will see whether they agree.
best — the order this archive was captured in
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.
Formulary criteria are revised, and plan renewal is a natural point at which a previously refused request may succeed without anything about the appli
Disagreeing with this line: that is an employer plan process and the provincial one differs.
Province added to the title. Coverage is provincial and the thread could not be answered without it.
The pharmacist sorted in five minutes what the phone line had not managed in a fortnight.
Have you seen the special authorization criteria for your province?
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.
What did the denial actually say?
ask the pharmacy what the cash price is, it varies
Which province?
Nothing here is medical or legal advice. The pharmacist and the prescriber are the people who can act, and both are faster than a forum.