Posting this because the summary going around does not say what the paper says, and the difference matters for how people here are using it.
The variables that decide how a cross-border order goes are declaration wording, the destination country's import rules for prescription medicines, and whether the shipment looks commercial. Personal-import allowances exist in some jurisdictions and not in others, and where they exist they are usually conditional on a prescription and a quantity limit. The failure mode is normally a seizure notice rather than anything worse, and a reshipment policy is the thing worth confirming before ordering rather than after.
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 trying to establish is which of the variables in a cross-border order actually determine the outcome, and which are superstition. I have searched first, so if this is covered somewhere point me at it and I will read it.
SteveThurs said:The variables that decide how a cross-border order goes are declaration wording, the destination country's import rules for prescription medicines,…
Agreed, and coverage criteria are plan-specific rather than insurer-specific. Two people with the same insurer and different employers have different rules, which is why "my insurer covers it" is not transferable information.
SteveThurs said:The variables that decide how a cross-border order goes are declaration wording, the destination country's import rules for prescription medicines,…
I read this differently from SteveThurs, on substance rather than tone. Import rules are jurisdiction-specific and this board keeps giving US-shaped answers to non-US questions. What is a personal-import allowance in one country is a controlled-import offence in another.
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Shop Reference StandardsThis one has a reasonably settled answer, so here it is. 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.
mike.trainer_LA said:Agreed, and coverage criteria are plan-specific rather than insurer-specific.
Adding a me-too, because a thread of one person's experience is not much use. I had assumed I was the exception until I read this.