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Single comment threadYou are looking at one branch of the formulary thing finally clicked for me and I want to write it down — 41 comments in the full submission. View in context.
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c/insurancefights·submitted 11 months ago by u/ines_krastev

the formulary thing finally clicked for me and I want to write it down

Appealbranch of 9 comments

Been lurking in c/glp1eu for about 2 months and finally have something worth posting. Short version: week 90, 7.5mg, and external review is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 29 threads, and the answers split roughly down the middle. What I actually want to…

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This branch

9 comments, started 11 months ago
u/adaeze_weiss83 points·11 months ago

resubmission after denial requires new documentation

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[removed]62 points·11 months ago

[removed by moderator]

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u/ireland_drugs_pay25 points·11 months ago·edited

external review is the appeal after insurance says no

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u/blunt_coldbox_notes32 points·11 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/marisol_moreau38 points·11 months ago

Which plan type? prior authorization is different.

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u/honest_syringe1918 points·11 months ago

external review is the appeal after insurance says no

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u/sock_puppet_spotter66 points·11 months ago

This is correct. Appeal letters work.

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u/ines_krastevOP28 points·11 months ago

Poland plan: step therapy required 2 medications first. Did them all, got approval. The order matters.

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u/ines_krastevOP-24 points·11 months ago

External review overturned the denial. Took 20 weeks but the process exists.

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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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