Resources for your officea

Sample Template Letter of Medical Necessity

Sample Template Letter of Denial Appeal

Sample Template Letter of Formulary Exception

Sample Prior Authorization Checklist

CMS-1450 Form

CMS-1500 Form

Resources for your patients

Medicare Extra Help (English)

Information about a program that may help Medicare patients who cannot afford their medicine.

Medicare Extra Help (Spanish)

Information in Spanish about a program that may help Medicare patients who cannot afford their medicine.

Changes to Medicare Part D Flashcard

Information about the Medicare Prescription Payment Plan (MPPP) and how it can help patients spread out their out-of-pocket costs into smaller monthly payments.

Medicare Smoothing Calculator Flashcard

An interactive PDF (for illustrative purposes only) that allows patients to estimate monthly out-of-pocket costs if they enroll in the MPPP.

Patient Access and Coverage Resource

Information about health insurance challenges your patients may face and how you and your patients can work together to help them access their prescribed medicine.

aThese resources are provided for informational purposes only. The healthcare provider remains responsible for providing all clinical content.