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Regional · North America · continued

Canadian access and provincial variation posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

RE
r.ekstromTL229 Jan 2025#31

A methods point on canadian access and provincial variation rather than a substantive one: if the comparison is not like for like, the difference you are measuring is the difference in method.

0 likes 18mo
EF
endo_fellow_rkTL3Endocrinology fellow29 Jan 2025#32
j.solberg, post #9: I disagree with the framing of canadian access and provincial variation above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked. The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do… Go to post

Prior authorisation criteria are usually published by the payer and reading them before the appointment changes the outcome more than anything else does.

29 likes in reply to #9 18mo
CA
c.amankwahTL229 Jan 2025#33
r.ekstrom, post #31: A methods point on canadian access and provincial variation rather than a substantive one: if the comparison is not like for like, the difference you are measuring is the difference in method. Go to post

Where I part company with post #31, and it is a narrow parting.

Regional variation in North America: access differs substantially by US state and Canadian province. Postcode is a major determinant of access.

10 likes in reply to #31 18mo
TH
TL4_HalvorsenTL4Leader · Journal club30 Jan 2025#34

Post #31 is the version of this I will quote in future. One addition.

Marking my uncertainty on canadian access and provincial variation explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post.

3 likes 18mo
SA
s.adebayoTL230 Jan 2025#35

This is the answer, and the reason it is the answer is the more useful part.

0 likes 18mo
FN
formulary_notesTL3Regular30 Jan 2025#36

Adding the measurement that post #34 says would settle it.

I have no financial interest in anything named in this thread and I want to say so before I comment on canadian access and provincial variation, because it is the sort of subject where it matters.

0 likes 18mo
LV
l.vukovicTL231 Jan 2025#37
n.nyberg, post #3: Adding the measurement that the opening post says would settle it. The most useful thing anyone has posted about canadian access and provincial variation in this category was a table of what had been measured and by whom. That is what I would want again. Go to post

Where I part company with post #36, and it is a narrow parting.

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.

Not disagreeing with anyone above, just adding the bit I keep having to look up.

15 likes in reply to #3 18mo
WP
weekly_pinTL2Regular31 Jan 2025 · edited#38

Two people in this thread mean different things by canadian access and provincial variation and are disagreeing about the definition while believing they are disagreeing about the facts. Worth pausing to define it.

5 likes 18mo
II
i.ilungaTL231 Jan 2025 · edited#39

Everything in post #36 holds. The case it does not cover is the one I have.

Indigenous healthcare systems: different indigenous healthcare systems have different medication access. Pathways through tribal health systems differ from mainstream healthcare.

Not the answer, but possibly the question that gets there.

30 likes 18mo
SL
sleep_logTL2Regular31 Jan 2025#40

The most useful contribution is the current published criterion with a link and an access date, rather than an account of what happened to somebody.

Adding a source would improve this post and I do not have one to hand.

15 likes 18mo
NR
n.ramosTL21 Feb 2025#41

Prior authorisation, step therapy, and exclusion of weight-management indications from coverage are common access barriers. The denial letter tells you which barrier you are facing.

That is what I would do. It may not be what is correct.

0 likes 18mo
I
IHollingworthTL2Member1 Feb 2025#42

Coming back to post #38, because the follow-up matters more than the original answer.

Practical experience of canadian access and provincial variation, offered as one case with the conditions stated, not as a general finding. Conditions first, because they are what make it interpretable.

0 likes 18mo
TM
t.marchettiTL21 Feb 2025 · edited#43
c.grimaldi, post #6: Say which country and which state or province. Regulatory position, availability and practical route can all differ within the same continent and frequently do. I would call that likely rather than established. Go to post

Canadian access and provincial variation: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this.

4 likes in reply to #6 18mo
LS
l.sarkissianTL2Member2 Feb 2025#44
h.almeida, post #15: Provincial formularies in Canada are published and are the correct source for coverage information. Coverage for weight management is less common than for diabetes. Go to post

Date every claim in this subcategory. Positions here have moved repeatedly and old posts are read as current.

13 likes in reply to #15 18mo
NK
ni.kravchenkoTL22 Feb 2025#45

Post #44 answers the question as asked. The question underneath it is different.

What I would check first on canadian access and provincial variation is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.

0 likes 18mo
R
RodriguesTL3Regular2 Feb 2025#46

I read post #42 twice before replying, because I had assumed the opposite.

Canada: Health Canada licenses compounds. Prescribing is provincial. Compounds are prescription-only. Coverage varies between public and private insurance.

That has held every time I have looked, which is not the same as always.

2 likes 18mo
RS
r.sobczakTL22 Feb 2025#47
r.jhannsdttir, post #11: Private insurance gaps: some people have private insurance but medication is not covered. Manufacturer assistance programmes are the main resource for cost reduction. Go to post

A definition problem is doing most of the work in this canadian access and provincial variation discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small.

8 likes in reply to #11 18mo
EA
e.almeidaTL2Member3 Feb 2025#48

This is the first time the answer has come with its own limits attached. Appreciated.

19 likes 18mo
AK
ak.kravchenkoTL23 Feb 2025#49
f.lindholm, post #23: Formulary position changes on a schedule that is published in advance, which means a decision made now may be answering last year's formulary. This is the version I would want a new member to read first. Go to post

Post #47 is the version of this I will quote in future. One addition.

On canadian access and provincial variation, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one.

19 likes in reply to #23 18mo
AD
ambient_draftTL3Regular3 Feb 2025#50

Nothing in this subcategory is medical or legal advice, and the clinicians posting here say so on their own account.

0 likes 18mo
CD
c.dahlbergTL23 Feb 2025#51

Everything in post #49 holds. The case it does not cover is the one I have.

Provincial formularies in Canada are published and are the correct source for coverage information. Coverage for weight management is less common than for diabetes.

That distinction has done more work for me than anything else in this category.

0 likes 18mo
IC
i.coelhoTL24 Feb 2025#52

Adding a note of thanks rather than an opinion. I did not know most of that.

32 likes 18mo
DP
d.petrescuTL24 Feb 2025#53
c.grimaldi, post #6: Say which country and which state or province. Regulatory position, availability and practical route can all differ within the same continent and frequently do. I would call that likely rather than established. Go to post

Cost comparisons should state whether they include the device and the dispensing fee, because those differ between routes and between states.

17 likes in reply to #6 18mo
JH
j.hartmannTL24 Feb 2025#54

The strongest argument against my own position on canadian access and provincial variation, stated as well as I can state it, since nobody else has yet.

6 likes 18mo
P
PSkarbekTL3Regular5 Feb 2025 · edited#55

I read post #53 twice before replying, because I had assumed the opposite.

Canadian access and provincial variation is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at.

1 like 18mo
BR
b.restrepoTL25 Feb 2025#56

Cross-border purchasing raises both a legal question and a practical one, and the legal one is yours to establish for your own jurisdiction.

0 likes 18mo
BM
buffer_marginTL3Regular5 Feb 2025#57
v.bergstrom, post #12: This follows post #9 rather than contradicting it. Reading this canadian access and provincial variation thread as someone who came in with a fixed view: the third and seventh replies moved me and the confident ones did not. Go to post

Canadian access and provincial variation sits at the boundary between what this community can usefully discuss and what it cannot, and I think it falls on the discussable side, narrowly.

23 likes in reply to #12 18mo
KA
k.agyemanTL25 Feb 2025#58

Taking post #57 at face value and following it one step further.

Trying to state the canadian access and provincial variation position in a way that someone who disagrees would recognise as fair, because I do not think the version in this thread passes that test.

11 likes 18mo
NK
n.krastevTL26 Feb 2025#59

Pharmacy practice varies between pharmacies within the same city, so two honest accounts can be entirely different.

0 likes 18mo
DO
d.oyelaranTL3Pharmacist6 Feb 2025#60

Where a manufacturer runs a direct supply route, that is a commercial arrangement rather than a regulatory change, and it can end.

It is the kind of thing that is obvious once and never again.

17 likes 18mo