Regional · North America

Telehealth prescribing models in the US

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s.karlsen_rphTL3Pharmacist26 Aug 2024#1

Telehealth prescribing models in the US Writing it up because I had to work it out twice and would rather nobody else did.

A coverage question with the paperwork detail included, since that is what determines the answer.

Denial received, with a stated reason. My reading of the reason is that it tells me exactly what to submit next, which is the useful thing about a well-written denial.

Before I spend a week on it: is my reading of the stated criterion correct, and is there a documented precedent for this specific ground?

49 likes 23mo

b.dumitruTL2 Moderator2 Sep 2024#2

Telehealth prescribing: widespread in the US and varying in quality. Models without a clinician reviewing measurements and history are not recommended by this community.

13 likes 23mo

k.redgraveTL2Member7 Sep 2024#3

Coming back to the opening post, because the follow-up matters more than the original answer.

Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.

2 likes 23mo

v.bruunTL2 Moderator12 Sep 2024 · edited#4

b.dumitru, post #2: Telehealth prescribing: widespread in the US and varying in quality. Models without a clinician reviewing measurements and history are not recommended by this community. Go to post

Provincial formularies in Canada are published and are the correct source for coverage information. Coverage for weight management is less common than for diabetes.

0 likes in reply to #2 23mo

d.moreauTL2Regular16 Sep 2024#5

v.bruun, post #4: Provincial formularies in Canada are published and are the correct source for coverage information. Coverage for weight management is less common than for diabetes. Go to post

Private insurance gaps: some people have private insurance but medication is not covered. Manufacturer assistance programmes are the main resource for cost reduction.

0 likes in reply to #4 22mo

r.lundgrenTL2 Moderator21 Sep 2024#6

post #5 is right about the mechanism and I think understates the practical bit.

Regional variation in North America: access differs substantially by US state and Canadian province. Postcode is a major determinant of access.

18 likes 22mo

electrolyte_notesTL2Regular24 Sep 2024#7

United States: FDA licenses compounds. Prescribing and pharmacy practice are state-regulated. Compounds are prescription-only. Coverage is decided by individual plans, not nationally.

4 likes 22mo

z.cardosoTL2 Moderator28 Sep 2024#8

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.

0 likes in reply to #2 22mo

RidgewayTL3Regular2 Oct 2024#9

electrolyte_notes, post #7: United States: FDA licenses compounds. Prescribing and pharmacy practice are state-regulated. Compounds are prescription-only. Coverage is decided by individual plans, not nationally. Go to post

On post #5 — agreed on the reasoning, with one qualification.

13 likes in reply to #7 22mo

i.grimaldiTL2 Moderator6 Oct 2024#10

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.

5 likes 22mo

t.duarteTL2 Moderator9 Oct 2024#11

k.redgrave, post #3: Coming back to the opening post, because the follow-up matters more than the original answer. Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive. Go to post

Cross-border purchase: buying in the US and bringing to Canada or vice versa involves both countries' import rules. The medication is legal but crossing borders with it is regulated.

27 likes in reply to #3 22mo

e.ferreiraTL3Regular12 Oct 2024#12

Worth separating two things that post #8 runs together.

Indigenous healthcare systems: different indigenous healthcare systems have different medication access. Pathways through tribal health systems differ from mainstream healthcare.

0 likes 21mo

a.jansenTL2 Moderator16 Oct 2024#13

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

4 likes 21mo

titration_diaryTL3Regular19 Oct 2024 · edited#14

Compounding pharmacies: pharmaceutical compounding of a drug not on the FDA shortage list is substantially constrained. The landscape changed when supply normalised. Current compounding availability is limited.

13 likes 21mo

r.zielinskiTL2 Moderator22 Oct 2024#15

Indigenous healthcare systems: different indigenous healthcare systems have different medication access. Pathways through tribal health systems differ from mainstream healthcare.

0 likes 21mo

lc_gradientTL3Analytical chemist25 Oct 2024#16

United States: FDA licenses compounds. Prescribing and pharmacy practice are state-regulated. Compounds are prescription-only. Coverage is decided by individual plans, not nationally.

0 likes 21mo

d.vukovicTL2 Moderator29 Oct 2024#17

Picking up post #14: that is the part I would want checked first.

Regional variation in North America: access differs substantially by US state and Canadian province. Postcode is a major determinant of access.

8 likes 21mo

dr_bhattacharyaTL3Physician1 Nov 2024#18

r.zielinski, post #15: Indigenous healthcare systems: different indigenous healthcare systems have different medication access. Pathways through tribal health systems differ from mainstream healthcare. Go to post

Private insurance gaps: some people have private insurance but medication is not covered. Manufacturer assistance programmes are the main resource for cost reduction.

19 likes in reply to #15 21mo

a.novakTL2 Moderator4 Nov 2024#19

Ridgeway, post #9: On post #5 — agreed on the reasoning, with one qualification. Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive. Go to post

post #18 is right about the mechanism and I think understates the practical bit.

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

0 likes in reply to #9 21mo

mira.patelTL4 Admin7 Nov 2024#20

titration_diary, post #14: Compounding pharmacies: pharmaceutical compounding of a drug not on the FDA shortage list is substantially constrained. The landscape changed when supply normalised. Current compounding availability is limited. Go to post

Staff post. Actions described here are recorded in the public moderation log and may be challenged in Meta.

Canada: Health Canada licenses compounds. Prescribing is provincial. Compounds are prescription-only. Coverage varies between public and private insurance.

2 likes in reply to #14 21mo

titration_diaryTL3Regular10 Nov 2024 · edited#21

Cross-border purchase: buying in the US and bringing to Canada or vice versa involves both countries' import rules. The medication is legal but crossing borders with it is regulated.

13 likes 21mo

h.falkTL2 Moderator13 Nov 2024#22

Provincial formularies in Canada are published and are the correct source for coverage information. Coverage for weight management is less common than for diabetes.

4 likes 20mo

sharps_binTL216 Nov 2024#23

Post hidden by community flags

Staff rationale: Hidden by community flags. The claim about a named supplier was not accompanied by a batch, a date, a method or a document, which R6 requires.

Coming back to post #21, because the follow-up matters more than the original answer.

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.

The corresponding entry is in the public moderation log. Hidden posts are never deleted.

i.boatengTL2 Moderator19 Nov 2024#24

Picking up post #21: that is the part I would want checked first.

Telehealth prescribing: widespread in the US and varying in quality. Models without a clinician reviewing measurements and history are not recommended by this community.

0 likes in reply to #15 20mo

dr_bhattacharyaTL3Physician21 Nov 2024#25

a.jansen, post #13: For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use. Go to post

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

19 likes in reply to #13 20mo

r.erdoganTL2 Moderator24 Nov 2024#26

post #25 is right about the mechanism and I think understates the practical bit.

8 likes 20mo

e.ferreiraTL3Regular27 Nov 2024#27

I read post #25 twice before replying, because I had assumed the opposite.

Private insurance gaps: some people have private insurance but medication is not covered. Manufacturer assistance programmes are the main resource for cost reduction.

2 likes 20mo

b.kowalskiTL2 Moderator30 Nov 2024#28

mira.patel, post #20: Canada: Health Canada licenses compounds. Prescribing is provincial. Compounds are prescription-only. Coverage varies between public and private insurance. Go to post

Regional variation in North America: access differs substantially by US state and Canadian province. Postcode is a major determinant of access.

0 likes in reply to #20 20mo

c.wijnbergTL2Member3 Dec 2024#29

r.lundgren, post #6: post #5 is right about the mechanism and I think understates the practical bit. Regional variation in North America: access differs substantially by US state and Canadian province. Postcode is a major determinant of access. Go to post

On post #25 — agreed on the reasoning, with one qualification.

Indigenous healthcare systems: different indigenous healthcare systems have different medication access. Pathways through tribal health systems differ from mainstream healthcare.

5 likes in reply to #6 20mo

da.bakkerTL2 Moderator5 Dec 2024#30

post #29 answers the question as asked. The question underneath it is different.

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

0 likes 20mo

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