Prescription
Forms and resources for prescription
20 resources in this category
Prescription Exception Request Letter
Template for requesting a formulary exception when a prescribed medication is not on your plan's drug list.
Step Therapy Exception Request Letter
Letter template for bypassing step therapy requirements when first-line medications have failed or are contraindicated.
Tier Exception Request Letter
Template for requesting a lower cost-sharing tier for a medication when no generic or preferred alternative exists.
Quantity Limit Override Request Letter
Letter template for requesting an exception to prescription quantity limits based on clinical necessity.
Brand Name Medication Exception Letter
Template for requesting brand-name medication when generic versions cause adverse reactions or are therapeutically inferior.
Medicare Part D Coverage Determination Guide
Guide to requesting coverage determinations and exceptions for Medicare Part D prescription drug plans.
Medicare Part D Redetermination Appeal Guide
How to file a redetermination appeal when your Medicare Part D plan denies a medication coverage request.
Specialty Pharmacy Prior Authorization Guide
Guide to navigating specialty pharmacy prior authorization for biologic, oncology, and other high-cost medications.
Prescription Drug Denial Appeal Letter
General appeal letter template for overturning denied prescription drug coverage with supporting medical evidence.
Insulin Coverage Appeal Letter
Appeal letter template for insulin coverage denials including specific insulin type medical necessity arguments.
ADHD Medication Prior Authorization Guide
Guide to prior authorization for ADHD medications including stimulants and non-stimulant alternatives for adults and children.
Biologic Medication Appeal Guide
Comprehensive guide to appealing denials for biologic medications used in autoimmune, oncology, and rare disease treatment.
Compound Medication Coverage Appeal Letter
Appeal letter for denied compounded medication coverage when commercially available formulations are unsuitable.
Pain Medication Prior Authorization Guide
Guide to obtaining prior authorization for pain management medications including documentation of alternative treatment trials.
Oncology Drug Prior Authorization Guide
Guide to prior authorization for chemotherapy and targeted cancer therapy drugs with NCCN guideline references.
Prescription Transfer and Mail Order Guide
Guide to transferring prescriptions to preferred pharmacies or mandatory mail-order programs to reduce out-of-pocket costs.
Patient Assistance Program Application Guide
How to apply for manufacturer patient assistance programs when insurance denies coverage for expensive medications.
Copay Assistance and Accumulator Adjustment Guide
Guide to navigating copay accumulators and maximizer programs that affect out-of-pocket cost calculations for specialty drugs.
Drug Formulary Exception Worksheet
Worksheet to document clinical justification for formulary exceptions including failed medication trials and adverse reactions.
Prescription Coverage Comparison Worksheet
Worksheet to compare prescription drug coverage across insurance plans during open enrollment.