This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Keep every document with dates in one place. An appeal months later is assembled from whatever you kept.
Nothing here is legal or medical advice, and appeal processes differ enough by jurisdiction and payer that specifics do not transfer.
Post #61 and I disagree about the size of the effect, not about the direction.
If someone has run Step therapy requirements properly I would rather read that than my own reconstruction of it. Posting mine only because the thread has gone quiet.
Taking post #61 at face value and following it one step further.
Agreed on Step therapy requirements, with one qualification that I think matters. The reasoning holds for the case as described. Change the starting assumption and it does not, and the starting assumption is the part nobody states.
Keep every document with dates in one place. An appeal months later is assembled from whatever you kept.
The arithmetic in post #65 is right; the assumption feeding it is the part to check.
Nobody has said the unglamorous part of Step therapy requirements yet, so: most of the variation is explained by things that are boring to write about and easy to check.
Same experience here, different supplier, so it is at least not unique to one of them.
Out-of-pocket costs: if insurance is not covering it, asking about patient assistance programmes run by manufacturers can reduce costs. Eligibility requirements exist but many people qualify.
Somebody will have a better source than mine, and I hope they post it.
Adding the measurement that post #69 says would settle it.
On Step therapy requirements the community has more anecdote than the confidence in this thread implies, and I include my own contribution in that.
Saving this. It is the version I will quote when the question comes round again.
Step therapy requirements came up in a thread eighteen months ago and was answered well. I cannot find it, which is itself the problem, so here is the reconstruction.
Worth separating two things that post #70 runs together.
A note on how Step therapy requirements gets discussed rather than on Step therapy requirements itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.
Post #73 answers the question as asked. The question underneath it is different.
Reimbursement changes: a compound covered one year might not be the next. A formulary decision in January can change by April. Checking again before refilling saves frustration.
Written in the hope of being told what I have missed.
Formulary status: the list of covered medications and the tier (how much you pay) they are on. Checking the current formulary before going to a clinic appointment saves surprise at the pharmacy.
The arithmetic on Step therapy requirements is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it.
Prior authorisation: pre-approval requirements and how to satisfy them. Most denials cite specific criteria. Understanding the criterion is the first step in satisfying it.
Take it as a starting point and not as a specification.
Reading rather than answering, but this is the post I would point somebody at.
Everything in post #77 holds. The case it does not cover is the one I have.
The documentation on Step therapy requirements is better than this thread and I say that as someone who has posted in the thread.
That is a fair summary of where the discussion has got to.
Small correction to my own earlier position on Step therapy requirements. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely.
Worth separating Step therapy requirements as a question about the compound from Step therapy requirements as a question about the documentation. They get answered by different people and only one of them is answerable here.
On post #83 — agreed on the reasoning, with one qualification.
Keep every document with dates in one place. An appeal months later is assembled from whatever you kept.
The variance between people here is larger than the effect being discussed.
Picking up post #83: that is the part I would want checked first.
My experience of Step therapy requirements contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that.
Answering the Step therapy requirements question as asked, then the question I think is meant. As asked: yes, with the qualification below. As meant: it depends on how the first measurement was taken.
Nothing to add, except that this is the answer I would give if asked.
The claim about Step therapy requirements upthread is stronger than its source supports. I have read the source. The source says "associated with" and the post says "causes".