[Discussion] the formulary advice in here is 2 years out of date
the formulary advice in here is 2 years out of date — a position I have arrived at slowly and would like tested. Numbers, in the order they matter: 2 years. Kept every form and reference number. When they had no record of a submission, I did. Criteria changed at plan renewal and the denial that had been immovable…
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.
Was this a denied authorization or a rejected claim?
Provincial plan, employer plan, or paying cash?
Have you seen the special authorization criteria for your province?
Is there a quantity limit involved rather than a coverage refusal?
the exception drug status route exists in several provinces
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
Same view — private and provincial plans are genuinely different processes with different appeal routes.