Dr.SurgeonPGH said:Denials are usually procedural rather than clinical, and the order that works reflects that.
Pushing back on Dr.SurgeonPGH here. 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.
One concrete data point for the thread. Keep the original post as written when you update it, and add the correction underneath. An edited-away mistake is invisible to the next person who makes it.
Correct me if the detail matters more than I have assumed.
Dr.BariatricHTX said:Small molecule does not automatically mean cheap.
Adding the part of the answer the thread has not reached. It is worth asking what the claim would look like if it were false. If nothing would look different, it is not a claim about the world and no amount of discussion will settle it.
Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.
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View ResultsFollowing on from Dr.Martinez — and this may be the naive question:
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.