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c/insurancefights·submitted 1 months ago by u/plain_titration_2024

reading formulary threads from 2024 and half of it aged badly

Discussionbranch of 8 comments

denial. That is the whole post, but I will justify it. Everything else people worry about in c/dosinglogs is downstream of it. Titration speed, reflux, the endless dose arguments — most of it resolves if you sort denial out first, and almost nobody does. I say this having got it wrong for 8 months. My ApoB was the…

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8 comments, started 1 months ago
u/line_petrov44 points·1 months ago

Strongly agree. Step therapy is predictable if you have the criteria.

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[removed]32 points·1 months ago

[removed by moderator]

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u/nikhil_asante34 points·1 months ago

Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.

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u/plain_titration_2024OP26 points·1 months ago

Strongly agree.

Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.

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u/tuva_kirchner-9 points·1 months ago

external review is the appeal after insurance says no

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u/purity_pedantanalytical20 points·1 months ago

resubmission after denial requires new documentation

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u/pavel_nkemelu9 points·1 months ago

Sceptical. If this were true we would see it reflected in the data and we do not.

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u/plain_titration_2024OP7 points·1 months ago

Copay was copay for the copay then another 13% of the total. Read the actual plan document.

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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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