formulary

formulary is doing more work than we give it credit for. Change my mind, genuinely — I have no stake in being right about this. External review, which is the most…

does denial actually matter or is it forum lore at this point. I would rather ask a basic question now than get this wrong quietly for two months. External review was…

reading denial threads from 2024 and half of it aged badly — a position I have arrived at slowly and would like tested. Missed a deadline because I counted from when I…

Canada — has anyone got a straight answer on special authorization. Searched first, found three threads that contradict each other, hence the post. Kept every form and…

The title is the whole question — can we stop arguing about formulary until somebody posts a number — but here is why I am asking. Nothing here is medical or legal…

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…

The title is the argument: the step therapy thing finally clicked for me and I want to write it down. Here is the rest of it. New plan year, entirely new criteria, and…

why does nobody talk about copay, and I want the answer with the reasoning attached rather than just the conclusion. Kept a log with every date, name of department and…

The title is the argument: unpopular opinion: most of what gets said here about step therapy is guesswork. Here is the rest of it. New plan year, entirely new criteria,…

provincial differences, mapped, with dates — a position I have arrived at slowly and would like tested. Employer-sponsored plans have their own criteria and appeal…

The title is the argument: approved after i sent them their own policy criteria back. Here is the rest of it. A denial letter is required to state a reason and to…

the province question that gets asked weekly, answered properly. It is the sort of thing everyone half-believes and nobody writes down. Kept every form and reference…

the formulary question that gets asked weekly, answered properly. Change my mind, genuinely — I have no stake in being right about this. Cash pricing, which people skip…

help me understand special authorization, I have read the wiki twice. I am not trying to be the "source?" guy. I would just like a source. The three separate questions…

unpopular opinion: most of what gets said here about formulary is guesswork. Not a hot take, just something I have not seen said plainly here. Step therapy requires…

three years of special authorization threads, summarised so you do not have to read them — a position I have arrived at slowly and would like tested. The pharmacist…

step therapy is doing more work than we give it credit for. Not a hot take, just something I have not seen said plainly here. Step therapy requires documented trial of…

why does nobody talk about Canada — that is what I am asking, and I have already read the wiki twice. Formulary criteria are revised, and plan renewal is a natural…

the formulary advice in here is 3 years out of date. Making the case below, and I expect to lose some of it in the comments. Figures up front so nobody has to dig: 3…

the denial advice in here is 3 years out of date, and I am aware this is a minority view on this board. 3 years — those are the numbers, and they are the ones I am…

The title is the whole question — can we stop arguing about copay until somebody posts a number — but here is why I am asking. Prior authorisation criteria are…

the Ontario answer is not the Alberta answer, which sounds obvious until you try to state the evidence for it. Criteria changed at plan renewal and the denial that had…

special authorization is not what most of this community thinks it is. That is the post. The justification is underneath. Moved provinces and the coverage position…

Thinking out loud about this: Germany: private plan, and what it actually costs here. Cash pricing, which people skip because they assume coverage is the only route.…

Question in the title, detail here: Canada — what am I missing here. Criteria changed at plan renewal and the denial that had been immovable simply did not apply any…