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c/insurancefights·submitted 1 year ago by u/rekha_vestergaard

[Question] how do you actually verify external review

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Been lurking in c/glp1eu for about 14 months and finally have something worth posting. Short version: week 7, 15mg, and denial is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 3 threads, and the answers split roughly down the middle. What I actually want to know is…

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4 comments, started 1 year ago
u/sofia_ferreira7 points·1 year ago·edited

Crossposting this to c/coldchain because the people who need it are not reading this community.

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u/line_petrov10 points·1 year ago

Crossposting this to c/coldchain because the people who need it are not reading this community.

Adding to this: formulary is doing more work than the comment implies.

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u/sofia_ferreira7 points·1 year ago

step therapy documentation is the weapon, use it

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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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