mike_nyc said:Denials are usually procedural rather than clinical, and the order that works reflects that.
Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. Small molecule does not automatically mean cheap. Price is set by what the market will bear and by patent life, not by cost of goods, and I would not assume the savings reach patients.
The figures, for anyone assembling their own picture. For anyone reading later: the numbers in this thread are worth checking against a primary source before you act on them, including mine. Half the figures circulating in this community trace back to a secondary summary that dropped a qualifier.
I would rather be corrected than agreed with, if it comes to it.
PharmD_Rodriguez said:Small molecule does not automatically mean cheap.
Adding the part of the answer the thread has not reached. The mechanism and the magnitude are separate questions. Agreeing that something happens says nothing about whether it happens enough to act on.
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Shop Reference StandardsA narrower follow-up, since the general answer is now clear:
What actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work?
Closing the loop on my own question.
Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.