[Meta] the Canada rule is doing its job and people should stop complaining
Proposal, not a decision: the Canada rule is doing its job and people should stop complaining. 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. Cash pricing, which people skip because they…
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
Agreed — write the application against the published criteria rather than around them.
a denial letter names a criterion, that is your handle
a denial letter names a criterion, that is your handle
This is why every thread here needs a province in it.
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ask the pharmacy what the cash price is, it varies
Correction: that is regulatory approval, not coverage. They are separate decisions by separate bodies.
Those criteria were revised at renewal, so the version quoted upthread is out of date.
Spent three weeks on what turned out to be a quantity limit rather than a coverage question.
Small fix — that formulary position is another province’s and does not apply here.
say the province or the answers will be wrong
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.
Quantity limits restrict how much may be dispensed in a period even where coverage exists.
laila_wojcik is right that a rejected claim and a denied authorization are different animals.