small win: step therapy stopped being a problem at week 35
Posting this because I searched for it and got nothing useful. Setup: 15mg, week 75, injection-site soreness present but not ruining anything. I changed exactly one variable — copay — and tracked it for 17 weeks. Result: a difference, but a small one, and well inside what I would call noise if someone else posted it.…
step therapy documentation is the weapon, use it
Did you get step therapy or outright denial?
Did you get step therapy or outright denial?
Disagree on that part. 97.9% and 97.6% on the same vial is normal.
Sceptical. If this were true we would see it reflected in the data and we do not.
prior auth criteria are state-specific, copay differs
Yeah, the denial code matters, it tells you what to fight.
External review overturned the denial. Took 13 weeks but the process exists.
formulary exclusions are negotiable sometimes
step therapy documentation is the weapon, use it
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.