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c/insurancefights·submitted 9 months ago by u/maren_sorensen

Denmark: step therapy, and what it actually costs here

Appealbranch of 4 comments

Been lurking in c/cryptopay for about 13 months and finally have something worth posting. Short version: week 16, 0.25mg, and step therapy is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 19 threads, and the answers split roughly down the middle. What I actually want to…

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4 comments, started 9 months ago
u/liv_vukovic86 points·9 months ago

Canada plan: step therapy required 24 medications first. Did them all, got approval. The order matters.

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u/niels_salinas48 points·9 months ago

External review overturned the denial. Took 22 weeks but the process exists.

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u/ismael_nwosu-14 points·9 months ago

external review is the appeal after insurance says no

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u/karim_restrepo24 points·9 months ago

Disagree. What you are describing is consistent with prior authorization, not with what you concluded.

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The paperwork war. Prior-authorisation criteria, denial reason codes, step-therapy documentation, external review, employer carve-outs, and the appeal letter templates the community has iterated on for three years. Mostly US-shaped but the tactics generalise.

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