Putting this up for argument rather than for agreement. I have read it twice and I am still not certain what it supports.
Denials are usually procedural rather than clinical, and the order that works reflects that. Get the denial reason in writing, because it names the criterion you failed. Then supply the documentation that criterion asks for — usually documented BMI with a comorbidity, or a failed prior therapy. Then appeal, and ask for a peer-to-peer review, because a prescriber talking to a reviewing clinician resolves a large fraction of denials that written appeals do not. Manufacturer copay assistance is separate and applies mainly to commercial insurance, and patient assistance programmes are means-tested rather than a discount.
Where I think it is weakest: the population was selected and supported in ways a real cohort is not, so I would read the effect size as a ceiling rather than an expectation.
What I am after is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work. I have searched first, so if this is covered somewhere point me at it and I will read it.
paige_pharma said:Denials are usually procedural rather than clinical, and the order that works reflects that.
Agreed, with a caveat about community reputation: it is a lagging indicator. Reports arrive weeks after orders, so a supplier can look excellent for a month after quality has already changed.
Correct me if the detail matters more than I have assumed.
paige_pharma said:Denials are usually procedural rather than clinical, and the order that works reflects that.
I read this differently from paige_pharma, on substance rather than tone. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.
If somebody has the primary source to hand I would rather cite it than paraphrase it.
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Browse GL BiochemThis one has a reasonably settled answer, so here it is. The pattern that distinguishes a bad batch from an exit is behaviour rather than product. A bad batch comes with communication, a reshipment offer and a batch number. An exit comes with slower replies, pressure toward less reversible payment methods, sudden discounting, and the same reassurance repeated without any new information. The product tells you less than the correspondence does.
DanielChem_CHI said:Agreed, with a caveat about community reputation: it is a lagging indicator.
Adding a me-too, because a thread of one person's experience is not much use.