formulary

Genuine question, and the title is the question: how do you actually verify copay. Spent six weeks arguing in general terms and got nowhere. Two paragraphs quoting…

someone explain prior authorization to me like I have not read a paper in years. I would rather ask a basic question now than get this wrong quietly for two months.…

Thinking out loud about this: unpopular opinion: most of what gets said here about Canada is guesswork. Formulary criteria are revised, and plan renewal is a natural…

help me understand denial, I have read the wiki twice. I would rather ask a basic question now than get this wrong quietly for two months. Asked for the policy bulletin…

the appeal thing finally clicked for me and I want to write it down. Not a hot take, just something I have not seen said plainly here. Step therapy requires documented…

Question in the title, detail here: help me understand formulary, I have read the wiki twice. Prior authorisation criteria are republished each plan year. A criterion…

The title is the argument: appeal — 22 things I got wrong before I got it right. Here is the rest of it. Prior authorisation criteria are republished each plan year. A…

external review is doing more work than we give it credit for, and I am aware this is a minority view on this board. Kept a log with every date, name of department and…

The title is the whole question — does appeal actually matter or is it forum lore at this point — but here is why I am asking. A denial letter is required to state a…

unpopular opinion: most of what gets said here about external review is guesswork. Making the case below, and I expect to lose some of it in the comments. Appeal…

peer-to-peer review: what to say and what to bring. Short post, long comment section, probably. New plan year, entirely new criteria, and the denial that had been…

reading formulary threads from 2024 and half of it aged badly. Making the case below, and I expect to lose some of it in the comments. Spent six weeks arguing in…

why does nobody talk about prior authorization. Searched first, found three threads that contradict each other, hence the post. External review was the thing that…

appeal is the most under-discussed thing on this board — a position I have arrived at slowly and would like tested. Employer-sponsored plans may be regulated…

special authorization is the most under-discussed thing on this board. I have gone back and forth on this for months. Quantity limits restrict how much may be dispensed…

Question in the title, detail here: how much of what we believe about private plan actually comes from Canada threads. Nothing here is medical or legal advice. The…

The title is the whole question — can we stop arguing about province until somebody posts a number — but here is why I am asking. Criteria changed at plan renewal and…

proposal — a flair for special authorization posts. Nothing about this affects the ranking maths, before anyone asks. Formulary criteria are revised, and plan renewal…

New Zealand: Canada, and what it actually costs here. Not a hot take, just something I have not seen said plainly here. Special authorization is a documented exception…

Genuine question, and the title is the question: how do you actually verify step therapy. Appeal deadlines run from the date on the determination letter. They are…

does the copay card stack with anything or is that a myth — that is what I am asking, and I have already read the wiki twice. External review, which is the most…

does private plan actually matter or is it forum lore at this point — that is what I am asking, and I have already read the wiki twice. Cash pricing, which people skip…

three years of copay threads, summarised so you do not have to read them. I have gone back and forth on this for months. Internal appeals are decided by the plan.…

The title is the argument: we are measuring external review at the wrong time and calling it noise. Here is the rest of it. Prior authorisation criteria are republished…

proposal — a flair for appeal posts. This affects how posts get sorted and removed, so it belongs in the open. Asked for the policy bulletin by number and wrote the…