private plan — 20 things I got wrong before I got it right
Something I keep coming back to: private plan — 20 things I got wrong before I got it right.
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.
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.
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
Happy to answer the boring questions. Those are usually the ones worth asking.
best — the order this archive was captured in
Province added to the title. Coverage is provincial and the thread could not be answered without it.
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.
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.