Prior authorisation: what the criteria usually require — a second dataset

Seconded. It reads as careful rather than confident, which is the right register.

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.

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.

This has been discussed before and I could not find the thread, so, again.

An honest declaration on Prior authorisation: I have a prior here and it is strong enough that you should weight what I say downward. Stating it rather than hiding it.

Narrowing post #26, because the general version has more than one answer.

What I want from this Prior authorisation thread is the list of things that would need to be true for the claim to hold. If we can write that list, we can check it.

Something worth flagging about Prior authorisation: the strongest-sounding claims in this thread are the ones with no source attached, which is the usual pattern and not a coincidence.

The arithmetic on Prior authorisation is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it.

I read post #58 twice before replying, because I had assumed the opposite.

I keep a log for Prior authorisation specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.

Where an exception process exists separately from an appeal, they are different routes with different criteria and using the wrong one loses time.