Tags · Access

insurance

Coverage decisions and how they are made.

32 topics 7 solved Group: Access

Related in this group: prior authorisation · appeals · formulary · cost per milligram · compounding · shortage · NHS · EMA · FDA · MHRA · personal import · telehealth

32 topics · page 1 of 2

Topic	Participants	Replies	Views	Activity
Follow-up: Prior authorisation: what the criteria usually require Access › Insurance & coverage insurance appeals formulary prior authorisation Solved 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.…	+95	100	9.1k	10h
Follow-up: External review after an internal denial Access › Insurance & coverage prior authorisation formulary insurance Solved Posting this under the heading it deserves: External review after an internal denial Everything below is what sits behind that. Proposing that External review deserves a maintained page rather than a…	+6	10	12k	15h
Coming back to: Telehealth prescribing models in the US Regional › North America telehealth FDA compounding insurance Posting this under the heading it deserves: Telehealth prescribing models in the US Everything below is what sits behind that. Telehealth prescribing models — I have the observation and I do not trust my…	+26	30	17k	17h
Prior authorisation: what the criteria usually require — a second dataset Access › Insurance & coverage prior authorisation insurance formulary appeals Posting this under the heading it deserves: Prior authorisation: what the criteria usually require — a second dataset Everything below is what sits behind that. Posting a small dataset on Prior authorisation.…	+67	74	19k	21h
An appeal that succeeded, with the letter structure Access › Insurance & coverage appeals formulary prior authorisation insurance On the subject in the title: An appeal that succeeded, with the letter structure Working notes rather than a conclusion. Appeal, and specifically the version of it that the documentation does not cover. The…	+12	16	15k	1d
An appeal that succeeded, with the letter structure — the long version Access › Insurance & coverage appeals formulary insurance An appeal that succeeded, with the letter structure — the long version — setting out what I have, and where I think it stops being reliable. A narrow question about appeal, deliberately narrow, because the…	+113	136	32k	1mo
External review after an internal denial Access › Insurance & coverage appeals prior authorisation insurance formulary Solved External review after an internal denial Writing it up because I had to work it out twice and would rather nobody else did. Proposing that external review deserves a maintained page rather than a recurring…		2	18k	1mo
Step therapy requirements and how to satisfy them Access › Insurance & coverage prior authorisation insurance formulary Posting this under the heading it deserves: Step therapy requirements and how to satisfy them Everything below is what sits behind that. I would like to know what people here actually do about step therapy…	+21	25	49k	2mo
About the Insurance & coverage category Access › Insurance & coverage insurance prior authorisation appeals Pinned Wiki Prior authorisation, appeals, denial letters, and documentation that helps. 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…	+2	6	3.2k	3mo
Follow-up: State-level differences that actually matter Regional › North America FDA telehealth insurance State-level differences that actually matter — setting out what I have, and where I think it stops being reliable. A follow-up question about State-level differences that I did not know to ask the first time.…	+90	96	4.1k	4mo
Peer-to-peer review: what actually happens on the call — one year on Access › Insurance & coverage appeals formulary insurance Peer-to-peer review: what actually happens on the call — one year on — setting out what I have, and where I think it stops being reliable. The question about Peer-to-peer review that I actually want answered…	+2	6	41k	5mo
Coverage in the US: a map of the usual obstacles Regional › North America FDA insurance telehealth compounding 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
Appeal templates and why they are deliberately unemotional Access › Insurance & coverage formulary insurance prior authorisation appeals Posting this under the heading it deserves: Appeal templates and why they are deliberately unemotional Everything below is what sits behind that. A narrow question about appeal templates, deliberately narrow,…	+25	29	764	7mo
Documentation that materially improves an appeal's chances Access › Insurance & coverage insurance appeals formulary prior authorisation Documentation that materially improves an appeal's chances — setting out what I have, and where I think it stops being reliable. An honest uncertainty about documentation rather than a disguised assertion. I…	+93	98	3.6k	8mo
Second pass at: Coverage in the US: a map of the usual obstacles Regional › North America insurance telehealth compounding FDA 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
About the North America category Regional › North America FDA compounding insurance Pinned Wiki 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
State-level differences that actually matter Regional › North America compounding telehealth insurance FDA Solved 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
Revisiting: Reading a denial letter as a specification for your appeal Access › Insurance & coverage prior authorisation insurance formulary appeals Posting this under the heading it deserves: Revisiting: Reading a denial letter as a specification for your appeal Everything below is what sits behind that. Asking about Reading a denial letter on behalf of…	+125	138	9.4k	10mo
[2026 update] US compounding rules and how they changed Regional › North America FDA compounding insurance Solved 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
Appeal templates and why they are deliberately unemotional — one year on Access › Insurance & coverage insurance appeals prior authorisation formulary Closed Appeal templates and why they are deliberately unemotional — one year on Writing it up because I had to work it out twice and would rather nobody else did. A narrow question about Appeal templates,…		2	4.1k	11mo
Reading a denial letter as a specification for your appeal Access › Insurance & coverage appeals prior authorisation insurance Closed Reading a denial letter as a specification for your appeal Writing it up because I had to work it out twice and would rather nobody else did. Reading back through what has been written here about reading a…		3	30k	12mo
An appeal that failed, and what I would do differently Access › Insurance & coverage insurance appeals prior authorisation An appeal that failed, and what I would do differently Writing it up because I had to work it out twice and would rather nobody else did. Asking about appeal directly, because I have read four threads on it…	+4	8	125	12mo
Canadian access and provincial variation — one year on Regional › North America FDA compounding insurance 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…	+43	47	964	12mo
[2026 update] An appeal that failed, and what I would do differently Access › Insurance & coverage prior authorisation insurance formulary Posting this under the heading it deserves: An appeal that failed, and what I would do differently Everything below is what sits behind that. Asking about appeal directly, because I have read four threads on…	+152	159	2.5k	13mo
Coverage for the indication versus for the drug Access › Insurance & coverage insurance formulary appeals prior authorisation Coverage for the indication versus for the drug — setting out what I have, and where I think it stops being reliable. The question about coverage that I actually want answered is the second one below. The…	+70	79	18k	14mo
Telehealth prescribing models in the US Regional › North America FDA compounding insurance telehealth Telehealth prescribing models in the US Writing it up because I had to work it out twice and would rather nobody else did. Trying to work out what would count as evidence on telehealth prescribing models,…	+95	102	6.1k	14mo
Coverage for the indication versus for the drug — a second dataset Access › Insurance & coverage prior authorisation appeals formulary insurance Solved Closed On the subject in the title: Coverage for the indication versus for the drug — a second dataset Working notes rather than a conclusion. Posting a small dataset on Coverage. It is mine, it is uncontrolled, and…	+46	50	41k	16mo
Prior authorisation: what the criteria usually require Access › Insurance & coverage prior authorisation formulary appeals insurance Solved On the subject in the title: Prior authorisation: what the criteria usually require Working notes rather than a conclusion. I would like to know what people here actually do about prior authorisation, as…	+9	13	3.2k	17mo
Canadian access and provincial variation Regional › North America compounding telehealth FDA insurance 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
[2026 update] Step therapy requirements and how to satisfy them Access › Insurance & coverage insurance appeals prior authorisation Step therapy requirements and how to satisfy them Writing it up because I had to work it out twice and would rather nobody else did. Something about Step therapy requirements does not reconcile and I would…	+111	122	3.4k	18mo

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