mike.trainer_LA said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

Pushing back on mike.trainer_LA 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. Give anything pharmacological four weeks before you judge it, and give anything measured weekly a four-point rolling average before you call it a trend.

PurityPaulOR said:

Small molecule does not automatically mean cheap.

There is a second half to this that has not been said yet. The version of this that has an answer is narrower than the version being asked. Narrow it and it becomes tractable; leave it broad and the thread will produce nine confident and incompatible replies.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

One thing that is still open after matt_MKE’s answer:

What actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work?

Reporting back.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.