formulary — 15 things I got wrong before I got it right
Posting this as a discussion rather than a claim: formulary — 15 things I got wrong before I got it right.
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
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.
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.
Ask me anything specific. Anything general I will probably get wrong.
best — the order this archive was captured in
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.
Is there a quantity limit involved rather than a coverage refusal?
Nothing here is medical or legal advice.
This is why every thread here needs a province in it.
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.
Kept every form and reference number. When they had no record of a submission, I did.