special authorization is the most under-discussed thing on this board
special authorization is the most under-discussed thing on this board. I have gone back and forth on this for months. 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. National regulatory approval establishes that a…
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.
Careful, that criterion was updated at renewal and the version you are quoting is superseded.
Health Canada approval is not coverage
private plans and provincial plans are different fights entirely
Health Canada approval is not coverage
elin_varga is right that a rejected claim and a denied authorization are different animals.
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.