[Private Plan] special authorisation approved on the second try
special authorisation approved on the second try. It is the sort of thing everyone half-believes and nobody writes down.
Kept every form and reference number. When they had no record of a submission, I did.
Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
The three separate questions people ask here as though they were one.
Is it approved for sale — a national regulatory question with one answer. Is it covered — a provincial or private-plan question with many answers. Can I actually get this quantity dispensed — a quantity-limit question that is separate from coverage and stops as many people.
Say which of the three you are asking and name your province and plan type. Threads that do this get answered in two replies; threads that do not generate a page of people talking past each other, all of them correct about somewhere else.
Sceptical readings welcome. The confident ones are the ones I distrust.
best — the order this archive was captured in
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.
Province added to the title. Coverage is provincial and the thread could not be answered without it.
keep every form, every date, every reference number
Push back: approval by the national regulator says nothing about whether any plan will pay.
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.
Health Canada approval is not coverage
Careful, that criterion was updated at renewal and the version you are quoting is superseded.
quantity limits are as common a barrier as coverage itself
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
That is an employer plan process, and the provincial route is different in both form and timeline.
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 decisions are provincial, so the province is the first fact
formulary decisions are provincial, so the province is the first fact
Adding the fastest step — ask the pharmacist. They can usually check in minutes.
- 1National regulatory approval establishes that a product may be sold. Whether…9 comments in this branch · started by u/diego_sorensen