Canadian access and provincial variation — one year on Writing it up because I had to work it out twice and would rather nobody else did.
A follow-up question about Canadian access and provincial variation that I did not know to ask the first time.
The earlier thread answered what I asked. What I should have asked is below, and I think it is the one that matters.
Two claims get bundled together under Canadian access and provincial variation and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.
Almost every disagreement in threads like this one dissolves once you say which of the two you are making.
The opening post and I disagree about the size of the effect, not about the direction.
The useful distinction on Canadian access and provincial variation is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.
Quietly grateful for the plain phrasing. Not every thread gets that.
The arithmetic in post #4 is right; the assumption feeding it is the part to check.
The denial letter is the specification for the appeal. It states a criterion and the job is to demonstrate that criterion in the letter's own language.
Posting it because the silence on this was starting to look like agreement.
On Canadian access and provincial variation, the part that usually goes wrong is that the question is asked as though it has one answer. It has a range, and the width of the range is the interesting bit.
If you can post the two or three numbers you are working from, several people here will check the arithmetic rather than argue about the conclusion.
Post #6 describes the usual case. This is about the unusual one.
Where a manufacturer runs a direct supply route, that is a commercial arrangement rather than a regulatory change, and it can end.
Anyone with a larger sample, please post it.
Adding the measurement that post #9 says would settle it.
Practical note on Canadian access and provincial variation: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.
The arithmetic in post #10 is right; the assumption feeding it is the part to check.
I changed my mind about Canadian access and provincial variation after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens.
Private insurance gaps: some people have private insurance but medication is not covered. Manufacturer assistance programmes are the main resource for cost reduction.
Not the answer, but possibly the question that gets there.
Say which country and which state or province. Regulatory position, availability and practical route can all differ within the same continent and frequently do.
Post #12 put the caveat in the right place and I want to underline it.
Formulary position changes on a schedule that is published in advance, which means a decision made now may be answering last year's formulary.
Not disagreeing with anyone above, just adding the bit I keep having to look up.
Narrowing post #14, because the general version has more than one answer.
Canada: Health Canada licenses compounds. Prescribing is provincial. Compounds are prescription-only. Coverage varies between public and private insurance.
It is one reading of the data and not the only reasonable one.
Everything in post #12 holds. The case it does not cover is the one I have.
Canadian access and provincial variation has been discussed here with more heat than it deserves, mostly because two definitions have been in play the whole time.
Pharmacy practice varies between pharmacies within the same city, so two honest accounts can be entirely different.
Seconded. It reads as careful rather than confident, which is the right register.
On post #16 — agreed on the reasoning, with one qualification.
Regional variation in North America: access differs substantially by US state and Canadian province. Postcode is a major determinant of access.
Reading it again, the caveat matters more than the finding.
The honest answer on Canadian access and provincial variation is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.
Most people get the first two right and then argue about the fourth.
This follows post #21 rather than contradicting it.
Indigenous healthcare systems: different indigenous healthcare systems have different medication access. Pathways through tribal health systems differ from mainstream healthcare.
Coming back to post #21, because the follow-up matters more than the original answer.
Canadian access and provincial variation 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.
Following this. I have the same question and no better information than the first post.
Post #21 and I disagree about the size of the effect, not about the direction.
Counterpoint on Canadian access and provincial variation, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.
Taking post #25 at face value and following it one step further.
Anyone reporting an outcome should give the stated reason rather than the verdict. The reason is the part somebody else can use.
I have seen it go both ways, which is why I hedge.
Coverage decisions are made by individual payers and vary within the same jurisdiction. A denial from one says nothing about another.
The short answer was in the first line; everything after is the working.
On Canadian access and provincial variation I would separate what is worth knowing from what is worth acting on. The first list is long and the second is short, and conflating them is how threads get heated.
The public assessment documents published at approval are free, detailed and largely unread here.
That is all the detail I have. Someone else will have more.