Cross-border purchasing raises both a legal question and a practical one, and the legal one is yours to establish for your own jurisdiction.
8 likes 12mo
Regional · North America · continued
Canadian access and provincial variation — one year on posts 31–48
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
d.fontaine, post #12: 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. Go to post
No notes. Posting so the count is not one.
Confirming post #31 from a second method, which matters more than confirming it from a second person.
Prior authorisation criteria are usually published by the payer and reading them before the appointment changes the outcome more than anything else does.
Written quickly, so the reasoning may be tighter than the wording.
0 likes 12mo
I had written a reply contradicting post #30 and deleted it. Here is what survived.
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.
I have written this out at length because the short version keeps being misread.
0 likes 12mo
Coverage decisions are made by individual payers and vary within the same jurisdiction. A denial from one says nothing about another.
Not a conclusion. A place to stand while looking for one.
12 likes 12mo
s.lundgren, post #22: 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. Go to post
Canadian access and provincial variation is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.
Coming back to post #34, because the follow-up matters more than the original answer.
Adding a small correction to the Canadian access and provincial variation summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.
2 likes 12mo
This follows post #37 rather than contradicting it.
Emotional language in an appeal does not help, however justified it is. The reviewer is checking criteria and the job is to make them checkable.
The general case is well covered; this is the awkward specific one.
18 likes 12mo
Worth separating two things that post #38 runs together.
Canada: Health Canada licenses compounds. Prescribing is provincial. Compounds are prescription-only. Coverage varies between public and private insurance.
I would rather post the uncertainty than round it away.
0 likes 12mo
crossover_review, post #3: 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. Go to post
On Canadian access and provincial variation the community has more anecdote than the confidence in this thread implies, and I include my own contribution in that.
glossary_desk, post #35: Coverage decisions are made by individual payers and vary within the same jurisdiction. A denial from one says nothing about another. Not a conclusion. A place to stand while looking for one. Go to post
The arithmetic in post #39 is right; the assumption feeding it is the part to check.
Both are useful and different. The account tells you what happens in practice; the criterion tells you what to write.
It is worth stating the boring hypothesis before the interesting one.
Formulary position changes on a schedule that is published in advance, which means a decision made now may be answering last year's formulary.
23 likes 12mo
Cross-border purchasing raises both a legal question and a practical one, and the legal one is yours to establish for your own jurisdiction.
10 likes 12mo
i.balogun, post #8: 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. Go to post
Everything in post #43 holds. The case it does not cover is the one I have.
Small methodological point on Canadian access and provincial variation: repeating a measurement is cheap and resolves most of what is being argued about here at no cost to anyone.
Narrowing post #43, because the general version has more than one answer.
Canadian access and provincial variation looks different depending on whether you are reading the primary literature or the summaries of it, and the difference is not in our favour.
1 like 12mo
Suggested topics
| Topic | Participants | Replies | Views | Activity |
|---|---|---|---|---|
|
About the North America category
US and Canadian regulation, compounding, and coverage. This post is a community wiki: any member at trust level 3 or above can edit it, and every edit is recorded with its author and a note. If the scope…
|
+3 | 7 | 43k | 9mo |
|
[2026 update] US compounding rules and how they changed
US compounding rules and how they changed Writing it up because I had to work it out twice and would rather nobody else did. Regional question, dated January 2026, because everything in this category expires.…
|
+32 | 37 | 7.4k | 10mo |
|
Coverage in the US: a map of the usual obstacles
Coverage in the US: a map of the usual obstacles — setting out what I have, and where I think it stops being reliable. Trying to establish the boundary conditions on coverage. The general claim is fine; I…
|
+46 | 50 | 7.9k | 5mo |
|
Second pass at: Coverage in the US: a map of the usual obstacles
On the subject in the title: Second pass at: Coverage in the US: a map of the usual obstacles Working notes rather than a conclusion. Two things I would like separated before anyone answers on Coverage,…
|
4 | 62k | 9mo | |
|
State-level differences that actually matter
On the subject in the title: State-level differences that actually matter Working notes rather than a conclusion. The question about state-level differences that I actually want answered is the second one…
|
+6 | 10 | 56k | 10mo |
Related topics — sharing the tags FDA, compounding, insurance
| Topic | Participants | Replies | Views | Activity |
|---|---|---|---|---|
|
Reading a regulatory notice rather than an article about it
Posting this under the heading it deserves: Reading a regulatory notice rather than an article about it Everything below is what sits behind that. Posting a small dataset on reading a regulatory notice. It is…
|
2 | 2.9k | 5mo | |
|
Canadian access and provincial variation
Posting this under the heading it deserves: Canadian access and provincial variation Everything below is what sits behind that. Trying to establish the boundary conditions on canadian access and provincial…
|
+74 | 80 | 7.7k | 18mo |
|
Labelling requirements for research chemicals
Labelling requirements for research chemicals — setting out what I have, and where I think it stops being reliable. The question about labelling requirements for research chemicals that I actually want…
|
+5 | 9 | 45k | 4mo |
|
About the North America category
US and Canadian regulation, compounding, and coverage. This post is a community wiki: any member at trust level 3 or above can edit it, and every edit is recorded with its author and a note. If the scope…
|
+3 | 7 | 43k | 9mo |
|
Import rules for personal quantities, by jurisdiction, dated
On the subject in the title: Import rules for personal quantities, by jurisdiction, dated Working notes rather than a conclusion. I was wrong about import rules for personal quantities in a thread last spring…
|
3 | 60k | 12mo |