[Pricing] ON vs AB vs BC, same product, same month
The title is the argument: ON vs AB vs BC, same product, same month. Here is the rest of 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.
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.
Screenshot none of this. Read the whole thread, including the parts where I am told I am wrong.
best — the order this archive was captured in
Pharmacy staff name removed. The pharmacy can stay in a pricing post.
Small fix — that formulary position is another province’s and does not apply here.
special authorization forms are published, read them before applying
Correction: that is regulatory approval, not coverage. They are separate decisions by separate bodies.
Has your plan renewed since the last time you applied?
Province in the title, please. Coverage is provincial and the thread is unusable without it.
Kept every form and reference number. When they had no record of a submission, I did.
That is an employer plan process, and the provincial route is different in both form and timeline.
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.
What did the denial actually say?
a rejected claim is not the same as a denied authorization
Was this a denied authorization or a rejected claim?
Push back: approval by the national regulator says nothing about whether any plan will pay.
employer plans have their own criteria and their own appeals
compare cash prices before assuming coverage is the only path
Cosigning on quantity limits. They stop as many people as outright denials do and get discussed far less.
Have you seen the special authorization criteria for your province?
Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
- 1Pharmacy staff name removed. The pharmacy can stay in a pricing post.8 comments in this branch · started by u/formulary_fighter