formulary — 11 things I got wrong before I got it right
formulary — 11 things I got wrong before I got it right. Not a hot take, just something I have not seen said plainly here. Special authorization is a documented exception process with published criteria. Applications that answer those criteria explicitly, point by point, fare better than general clinical narratives.…
Push back: approval by the national regulator says nothing about whether any plan will pay.
Right, and the pharmacist can usually give a definite answer faster than a week of forum speculation.
Have you seen the special authorization criteria for your province?
Same view — private and provincial plans are genuinely different processes with different appeal routes.
employer plans have their own criteria and their own appeals
keep every form, every date, every reference number
formulary decisions are provincial, so the province is the first fact
Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.