Prior authorization appeal tool

Prior authorization requires providers to obtain advance approval before performing a service to qualify for payment coverage. Prior authorization for medications usually involve brand-name products for which there is no generic equivalent, or a drug that a patient has taken for years but for which the insurance carrier now requires annual re-authorization.

The Academy has created a customizable, clinically specific tool to allow your practice to easily download prior authorization appeal letters for select dermatologic drugs and diseases.

Create an appeal letter using the tool below.

Step {{index}} of {{steps.length-1}}

Prior Authorization Drug Denial Letter Template

Complete the following steps to create an individualized letter appealing a denial for a prescribed treatment for your patient.

Dermatologic disease with ICD-10 diagnosis code

Name of drug

Alternative Treatment Drug Options

For step therapy protocols, select drug/treatment the insurance company is requiring you to prescribe your patient as an alternative treament (skip if not applicable)

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Patient name

Patient health insurance identification number

Patient date of birth

Date of prior authorization

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I have previously prescribed this patient the following therapies (optional):

Prescribed from {{ convertDatePickerDate(medication.startDate) }} to {{ convertDatePickerDate(medication.endDate) }}

Reasoning: {{ medication.stopReason }}

Name of medication

Dates prescribed

From

Reason for stopping medication

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Click the button below to download your prior-authorization letter template.

Download Letter

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Prior authorization