Posting this because the summary going around does not say what the paper says, and the difference matters for how people here are using it.
Denials are usually procedural rather than clinical, and the order that works reflects that. Get the denial reason in writing, because it names the criterion you failed. Then supply the documentation that criterion asks for — usually documented BMI with a comorbidity, or a failed prior therapy. Then appeal, and ask for a peer-to-peer review, because a prescriber talking to a reviewing clinician resolves a large fraction of denials that written appeals do not. Manufacturer copay assistance is separate and applies mainly to commercial insurance, and patient assistance programmes are means-tested rather than a discount.
Where I think it is weakest: the population was selected and supported in ways a real cohort is not, so I would read the effect size as a ceiling rather than an expectation.
The bit I cannot resolve on my own is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work. If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
paige_pharma said:Denials are usually procedural rather than clinical, and the order that works reflects that.
Right, and one flattering data point from a group buy is not consistency. Consistency means separate batches, separately commissioned, over months.
Correct me if the detail matters more than I have assumed.
paige_pharma said:Denials are usually procedural rather than clinical, and the order that works reflects that.
Pushing back on paige_pharma here. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.
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PharmacoVig_BOS said:Right, and one flattering data point from a group buy is not consistency.
Mine went the same way, slower.