Follow-up: Prior authorisation: what the criteria usually require

Prior authorisation: what the criteria usually require — setting out what I have, and where I think it stops being reliable.

A methods question rather than a substantive one, about Prior authorisation.

Everyone quotes the same figure and I cannot find anyone who says how it was arrived at. That is not an accusation; it usually means the derivation is somewhere obvious and I have missed it.

Confirming post #30 from a second method, which matters more than confirming it from a second person.

The useful distinction on Prior authorisation 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.

I had written a reply contradicting post #45 and deleted it. Here is what survived.

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.

One more caveat and then I will stop qualifying: the sample selected itself.

On Prior authorisation, 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.

What does not work: describing how the decision made you feel, however justified. The reviewer is checking criteria and the job is to make them checkable.

The single most useful preparation is obtaining the actual criteria document rather than working from what somebody was told on the phone.

I have seen it go both ways, which is why I hedge.

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

Coming back to post #94, because the follow-up matters more than the original answer.

Prior authorisation is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers.