denial: what the trials say vs what this community says
Something I noticed reading old threads that I have not seen said out loud.
The advice on formulary in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers with the same confidence.
I have listed what I think the current consensus is below. Correct me — that is the point of posting it.
best — the order this archive was captured in
Half-life is about 168 hours, so steady state lands around week 11–5. Practical consequence: what you feel in week 1 is not what that dose does.
I am going to push back on this slightly.
Yeah, the denial code matters, it tells you what to fight.
That is net peptide content, not purity. Different number, different meaning.
the carve-out clause varies by employer
Small correction: the trial was 22 weeks, not 12. Does not change your point but people will quote it.
External review overturned the denial. Took 3 weeks but the process exists.
This is correct. Appeal letters work.
say which country and which plan type
say which country and which plan type
Yes, exactly this, and it is the bit that took me 51 weeks to accept.
Slight fix: the number was 99.0, not 98.9. Decimal point, but a fairly consequential one.
Sweden plan: step therapy required 14 medications first. Did them all, got approval. The order matters.
External review overturned the denial. Took 9 weeks but the process exists.
formulary exclusions are negotiable sometimes
Sweden plan: step therapy required 14 medications first.
Yes, exactly this, and it is the bit that took me 30 weeks to accept.
step therapy documentation is the weapon, use it
You have restated the marketing copy. What is the actual substance here.
say which country and which plan type
say which country and which plan type
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
say which country and which plan type
Disagree on that part. 95.1% and 99.3% on the same vial is normal.
Not to be pedantic but external review and formulary are being used interchangeably and they are not interchangeable in real life.
Yeah, the denial code matters, it tells you what to fight.
step therapy documentation is the weapon, use it
This is the "correlation is mechanism" thing again. You changed three variables at once.
prior auth criteria are state-specific, prior authorization differs
Flair changed to match the content. Read the sidebar before posting next time and we are square.
- 1step therapy documentation is the weapon, use it6 comments in this branch · started by u/ignacio_vanhecke
- 2Yeah, the denial code matters, it tells you what to fight.5 comments in this branch · started by u/RetaAndRegret2