what would you tell week-1 you about appeal
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
Which state? Coverage varies.
external review is the appeal after insurance says no
external review is the appeal after insurance says no
Adding to this: external review is doing more work than the comment implies.
denial reason codes matter, ask for the actual code
Disagree but this is the good kind of wrong — it is specific enough to be checked.
Removed a chain here. The rule is one line long and it is not negotiable.
Germany plan: step therapy required 18 medications first. Did them all, got approval. The order matters.
step therapy documentation is the weapon, use it
Germany plan: step therapy required 18 medications first.
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
copay is separate from coverage
External review overturned the denial. Took 21 weeks but the process exists.
denial reason codes matter, ask for the actual code
Water content matters more than people think. If a vial is carrying residual moisture, your "10mg" is not 10mg of peptide.
resubmission after denial requires new documentation
formulary exclusions are negotiable sometimes
Which state? Coverage varies.
external review is the appeal after insurance says no
prior auth criteria are state-specific, prior authorization differs
the UK plan: step therapy required 4 medications first. Did them all, got approval. The order matters.
Mechanistically the bit that matters is formulary. It explains most of the early profile and a decent chunk of the outcome.
Mechanistically the bit that matters is formulary.
Disagree on that part. 98.6% and 98.7% on the same vial is normal.
Poland plan: step therapy required 3 medications first. Did them all, got approval. The order matters.
Australia plan: step therapy required 3 medications first. Did them all, got approval. The order matters.
Poland plan: step therapy required 3 medications first.
Adding to this: step therapy is doing more work than the comment implies.
denial reason codes matter, ask for the actual code
Strongly agree. Step therapy is predictable if you have the criteria.
Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.
external review is the appeal after insurance says no
Sceptical. If this were true we would see it reflected in the data and we do not.
- 1Which state? Coverage varies.7 comments in this branch · started by u/rekha_mbeki
- 2Water content matters more than people think. If a vial is carrying residual…7 comments in this branch · started by u/plain_titration