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u/step_therapy_s

Step therapy means failing something cheaper first. Document the failure properly.

member · joined 18 Apr 2024

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Comments — page 3 of 3

comment on [Vendor] HJ vs QYB on the same compound, same month — both cleared 97.0% in c/coa · 17 points · 1 year ago

Area percent is the peak area of your compound over the total integrated area, at one wavelength, on one gradient. It is a relative measure of what the detector saw, not a mass fraction of the vial.

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comment on cycle — 11 things I got wrong before I got it right in c/glp1women · -26 points · 1 year ago

Questions about oral contraceptive absorption and gastric emptying are legitimate pharmacology questions with product-specific answers. A pharmacist can answer them properly; a board cannot.

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comment on [Discussion] ferritin is doing more work than we give it credit for in c/bloodwork · 34 points · 1 year ago

This. Reference ranges are population intervals, not targets, and conflating them causes a lot of unnecessary alarm here.

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comment on [Question] area percent — what am I missing here in c/coa · 67 points · 1 year ago

Area percent is the peak area of your compound over the total integrated area, at one wavelength, on one gradient.

Disagree on this specific point. Two honest labs can resolve that impurity differently and report different numbers.

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comment on the step therapy question that gets asked weekly, answered properly in c/insurancefights · 19 points · 1 year ago

Has a peer-to-peer been offered or requested?

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comment on [Question] is 99.0% actually fine or am I being sold a rounding error in c/coa · 405 points · 1 year ago

I would not read a rounded figure as evasive. Plenty of documents round to one decimal as house style.

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comment on how much of what we believe about appeal actually comes from formulary threads in c/insurancefights · 1 points · 1 year ago

Same view. The second-level appeal is where mine turned, after a first-level denial that looked final.

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comment on why does nobody talk about copay in c/insurancefights · 11 points · 1 year ago

Member and policy numbers redacted from the screenshot above. Everything else left as posted.

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comment on related substances — 9 things I got wrong before I got it right in c/coa · 203 points · 1 year ago

Right, and net peptide content is where the counterion and the water go. Both numbers can be honest and very different.

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comment on tried ApoB for 18 weeks. here is what happened. in c/bloodwork · 212 points · 1 year ago

The confounding problem, stated plainly, because this board keeps stepping on it.

Substantial weight loss moves lipids, liver enzymes, insulin sensitivity markers and several others in its own right. If you are losing weight while taking something, any change in those markers has at least two candidate explanations and you cannot separate them from your own panel.

What you can do is standardise, take a baseline, keep the series long, and be honest in your posts about what is and is not attributable. The threads that say "this compound did X to my TSH" almost never have the design to support the claim, mine included.

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comment on [Discussion] the purity advice in here is 3 years out of date in c/coa · 46 points · 1 year ago

a certificate with no method line is decorative

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comment on the batch question that gets asked weekly, answered properly in c/coa · 6 points · 1 year ago

Started keeping a folder of every certificate I have been sent. The ones that itemise impurities are a small group and they are mostly the same suppliers.

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comment on ferritin — 15 things I got wrong before I got it right in c/bloodwork · 9 points · 1 year ago

Small fix — a reference interval is not a treatment target, and the post above uses them interchangeably.

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comment on genuine question about denial that I am slightly embarrassed to ask in c/insurancefights · 60 points · 1 year ago

Spent six weeks arguing in general terms and got nowhere. Two paragraphs quoting their own criteria turned it around in eleven days.

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comment on [Question] Ireland — has anyone got a straight answer on shortage list in c/compounding · 139 points · 1 year ago

A 503A pharmacy compounds for an identified patient against a prescription. A 503B outsourcing facility registers with the regulator, may produce without patient-specific prescriptions, and is subject to current good manufacturing practice requirements. The two are governed differently and the difference is not cosmetic.

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comment on [Discussion] the appeal advice in here is 3 years out of date in c/insurancefights · 277 points · 1 year ago

Appeal deadlines run from the date on the determination letter. They are strict, they are short, and a missed deadline usually forfeits that level entirely.

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comment on reading lipids threads from 2024 and half of it aged badly in c/bloodwork · 25 points · 1 year ago

Substantial weight loss independently moves lipids, liver enzymes and several other markers. Attributing a change to a compound while losing weight is confounded by design.

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comment on week 59 check-in — 17kg down, early fullness manageable, one thing confusing me in c/sideeffects · 17 points · 1 year ago

sulphur burps are unpleasant and they are not dangerous

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comment on how much of what we believe about appeal actually comes from step therapy threads in c/insurancefights · 258 points · 1 year ago

Member and policy numbers redacted from the screenshot above. Everything else left as posted.

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comment on sulphur burps: the version I wish someone had shown me in week 1 in c/sideeffects · 59 points · 1 year ago

The pattern almost everyone here describes, written out once so it can be linked.

A step up is followed by a rough window — commonly reflux arriving the day after the shot and easing by day four, worst in the first fortnight, then flattening out. At a stable dose it usually settles further. Constipation and fatigue tend to track intake and fluid rather than the compound directly, which is why the unglamorous answers work.

What sits outside that pattern: severe pain, symptoms that appear from nowhere weeks into a stable dose, or anything getting worse rather than better over a month. None of that is a board question and none of us can answer it for you.

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comment on reading prior authorization threads from 2024 and half of it aged badly in c/insurancefights · 175 points · 1 year ago

Member and policy numbers redacted from the screenshot above. Everything else left as posted.

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comment on [Discussion] can we stop arguing about baseline labs until somebody posts a number in c/bloodwork · 109 points · 1 year ago

Brought the whole set to my clinician rather than one flagged value. Completely different conversation.

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comment on is it normal to get muscle cramps at week 90 in c/bloodwork · 18 points · 1 year ago

Is that the same assay, or did the lab change platforms?

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comment on 7 months in and cycle is still the thing I get wrong in c/glp1women · -23 points · 1 year ago

Why the evidence base here is thin, which is not your imagination.

The major trial programmes were designed around endpoints that do not answer most of the questions this board asks: cycle interactions, contraception, fertility, perimenopause. The populations were not enrolled to answer them and the endpoints were not chosen to measure them.

So when you search and find nothing, that is usually the actual state of the literature rather than a failure of searching. What follows practically: be precise about your question, take the pharmacology parts to a pharmacist who can look up product-specific information, and treat confident answers on this board — including the ones that agree with you — with more caution than usual.

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comment on three years of water content threads, summarised so you do not have to read them in c/coa · 408 points · 1 year ago

net peptide content and purity are two different numbers on the same vial

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comment on genuine question about nausea that I am slightly embarrassed to ask in c/sideeffects · 24 points · 1 year ago

Are you eating in the couple of hours before you sleep?

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comment on genuine question about nausea that I am slightly embarrassed to ask in c/sideeffects · 145 points · 1 year ago

Reflux was the one that got me. Stopped eating in the three hours before bed and it went from nightly to almost never.

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comment on genuine question about nausea that I am slightly embarrassed to ask in c/sideeffects · 25 points · 1 year ago

That symptom is not the one being described upthread. Two different things with similar names and the answers are not interchangeable.

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comment on genuine question about nausea that I am slightly embarrassed to ask in c/sideeffects · 33 points · 1 year ago

eating slower does more than most of the supplements people recommend

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comment on help me understand telehealth, I have read the wiki twice in c/compounding · 1 points · 1 year ago

Potency and sterility testing on the finished preparation are separate from any certificate covering the starting material.

camila_sandvik is right about the concentration trap. It breaks arithmetic that has been reliable for months.

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comment on [Meta] the area percent rule is doing its job and people should stop complaining in c/coa · 67 points · 1 year ago

area% is not mass%, and the difference is the whole game

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comment on [Discussion] can we stop arguing about eGFR until somebody posts a number in c/bloodwork · 776 points · 1 year ago

Different laboratories use different assay platforms with different calibration. Comparing across labs adds a systematic offset that is invisible on the report.

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comment on my TSH moved and I cannot work out whether sulphur burps are why in c/sideeffects · 84 points · 2 years ago

Same pattern here. It settled at a stable dose without me doing anything clever.

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comment on why does nobody talk about waist in c/dosinglogs · 44 points · 2 years ago

one line a week beats a spreadsheet you abandon

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comment on reflux: what the trials say vs what this community says in c/sideeffects · 1 points · 2 years ago

I would be careful here. "Everyone gets this" is not true, and it makes the people who get something unusual assume they are fine when they should be asking.

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comment on someone explain prior authorization to me like I have not read a paper in years in c/insurancefights · 46 points · 2 years ago

Added a jurisdiction tag — the answers differ completely between countries and plan types.

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comment on unpopular opinion: most of what gets said here about state board is guesswork in c/compounding · 84 points · 2 years ago

That figure is the starting material purity, not the finished preparation potency. Two different tests.

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comment on [Discussion] we are measuring appeal at the wrong time and calling it noise in c/insurancefights · 41 points · 2 years ago

Added a jurisdiction tag — the answers differ completely between countries and plan types.

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comment on [Discussion] the nausea advice in here is 3 years out of date in c/sideeffects · 3 points · 2 years ago

Which day of the week relative to the shot does it hit?

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comment on [Question] step therapy — what am I missing here in c/insurancefights · 117 points · 2 years ago

a template letter that quotes their own criteria back is the strongest one

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