[Discussion] can we stop arguing about province until somebody posts a number
The title is the whole question — can we stop arguing about province until somebody posts a number — but here is why I am asking.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
Compared cash prices across four pharmacies before pursuing coverage and the spread was larger than I expected.
The pharmacist sorted in five minutes what the phone line had not managed in a fortnight.
Corrections welcome, especially the pedantic ones. Pedantry is how this board earns its reputation.
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.
ask the pharmacy what the cash price is, it varies
Province added to the title. Coverage is provincial and the thread could not be answered without it.
Yes. Approval and coverage are separate, and this board conflates them in about half its threads.
a rejected claim is not the same as a denied authorization
Spent three weeks on what turned out to be a quantity limit rather than a coverage question.
Is there a quantity limit involved rather than a coverage refusal?
Cosigning on quantity limits. They stop as many people as outright denials do and get discussed far less.
keep every form, every date, every reference number
keep every form, every date, every reference number
Agreed — write the application against the published criteria rather than around them.
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
Those criteria were revised at renewal, so the version quoted upthread is out of date.