This site is intended for US healthcare professionals only.

HCP Tools

Access Sample Letters of Appeal and Medical Necessity below.

Prescribing Ohtuvayre

Here are two options for accessing these letters:

Download: Click the button to download a Word document with detailed instructions for completing the sample letters.

Open: Click the button to open a new tab with a PDF form featuring blank fields for quick and easy completion.

Sample Letter of Medical Necessity

A template to help guide you when writing a letter of medical necessity.

Sample Letter of Appeal

A template to help guide you when submitting an appeal when coverage has been denied by the plan.