[Discussion] the copay advice in here is 4 years out of date
external review. That is the whole post, but I will justify it.
Everything else people worry about in c/dosinglogs is downstream of it. Titration speed, muscle cramps, the endless dose arguments — most of it resolves if you sort external review out first, and almost nobody does.
I say this having got it wrong for 21 months. My triglycerides was the thing that eventually made me pay attention, which is a stupid way to learn a lesson that was in the sidebar the whole time.
best — the order this archive was captured in
This is correct. Appeal letters work.
Retitled to remove editorialising. Put the evidence in the body.
Mechanistically the bit that matters is appeal. It explains most of the early profile and a decent chunk of the outcome.
external review is the appeal after insurance says no
external review is the appeal after insurance says no
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
step therapy documentation is the weapon, use it
resubmission after denial requires new documentation
the carve-out clause varies by employer
the carve-out clause varies by employer
Disagree on that part. 98.1% and 97.6% on the same vial is normal.
copay is separate from coverage
This is correct. Appeal letters work.
What was the denial code?
resubmission after denial requires new documentation
This is correct.
Disagree on that part. 98.6% and 98.7% on the same vial is normal.
This is correct.
Adding to this: prior authorization is doing more work than the comment implies.
- 1This is correct. Appeal letters work.6 comments in this branch · started by u/niels_salinas
- 2Retitled to remove editorialising. Put the evidence in the body.4 comments in this branch · started by u/step_therapy_s