Prior authorization appeal tool
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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.
Alternative Treatment Drug Options
For step therapy protocols, select drug/treatment the insurance company is requiring you to prescribe your patient as an alternative treatment (skip if not applicable)
I have previously prescribed this patient the following therapies (optional):
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Prescribed from {{ convertDatePickerDate(medication.startDate) }} to {{ convertDatePickerDate(medication.endDate) }}
Reasoning: {{ medication.stopReason }}
Dates prescribed
Click the button below to download your prior-authorization letter template.
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