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c/insurancefights·posted 4 months ago by u/honest_syringe19

[Results] 81 weeks on 2.4mg, full numbers, ask me anything boring

Template

Right, the formulary question again, but with numbers this time.

I have 6 data points over 10 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign.

The thing I would flag for anyone new: the effect I am describing showed up at week 83, not week 37. People give up long before the interesting part.

Interested in whether this matches other people's logs or whether I am an outlier.

126 up / 42 down75% upvoted14 commentsid 1fwoev8 Mar 2026

14 comments

14 in this archive, depth 4

best — the order this archive was captured in

u/nnt_nate10 points·4 months ago
genuinely useful, thanks
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u/marta_vanhecke7 points·4 months ago

redact member ids and group numbers from every screenshot

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[deleted]5 points·4 months ago

[deleted]

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u/appeal_letter_al2 points·4 months ago

the carve-out clause varies by employer

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u/elin_lindqvist8 points·4 months ago

Which state? Coverage varies.

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u/coring_the_stopper2 points·4 months ago

Strongly agree. Step therapy is predictable if you have the criteria.

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u/appeal_letter_alMOD7 points·4 months ago

Flair changed to match the content. Read the sidebar before posting next time and we are square.

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u/liv_vukovic5 points·4 months ago

Sceptical. If this were true we would see it reflected in the data and we do not.

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u/honest_syringe19OP4 points·4 months ago

denial reason codes matter, ask for the actual code

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u/honest_syringe19OP2 points·4 months ago

External review overturned the denial. Took 7 weeks but the process exists.

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u/honest_syringe19OP3 points·4 months ago

The confident tone is doing a lot of work that the evidence is not.

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About c/insurancefights

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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