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c/insurancefights·submitted 4 months ago by u/ireland_drugs_pay

formulary: the version I wish someone had shown me in week 1

Questionbranch of 5 comments

step therapy. That is the whole post, but I will justify it. Everything else people worry about in c/dosinglogs is downstream of it. Titration speed, early fullness, the endless dose arguments — most of it resolves if you sort step therapy out first, and almost nobody does. I say this having got it wrong for 17…

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5 comments, started 4 months ago
u/milan_wikstrom70 points·4 months ago

say which country and which plan type

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u/greta_chukwu0 points·4 months ago

Not convinced. The evidence does not support that reading.

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u/milan_wikstrom1 point·4 months ago

redact member ids and group numbers from every screenshot

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u/ireland_drugs_payOP38 points·4 months ago

This is correct. Appeal letters work.

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u/niels_salinas103 points·4 months ago

This is correct. Appeal letters work.

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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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