Step therapy not completed
Step therapy override appeal letter
Denials requiring a patient to fail cheaper drugs first when that is clinically inappropriate.
Use this letter to formally appeal a "step therapy not completed" denial. Replace every {{PLACEHOLDER}} with your own facts, attach the listed evidence, and send it certified mail plus by the insurer's online portal.
Template
{{MEMBER_NAME}}
{{MEMBER_ADDRESS}}
{{MEMBER_PHONE}}
Member ID: {{MEMBER_ID}}
Claim / Reference #: {{CLAIM_NUMBER}}
Date of Service: {{DATE_OF_SERVICE}}
Date of Denial Notice: {{DENIAL_DATE}}
{{INSURER_NAME}}
Appeals and Grievances Department
{{INSURER_APPEAL_ADDRESS}}
Re: Formal Internal Appeal — {{CLAIM_NUMBER}}
I am requesting a step therapy override / exception and appealing the denial of {{DRUG_NAME}}.
Clinical basis for override:
• Previously tried and failed: {{PRIOR_DRUGS_FAILED}} on {{DATES}}.
• Contraindication or intolerance to {{STEP_DRUG}}: {{CLINICAL_REASON}}.
• Delay in appropriate therapy will likely cause: {{HARM_STATEMENT}}.
My prescribing physician attests (see attached letter) that requiring me to try {{STEP_DRUG}} is medically inappropriate.
Please approve {{DRUG_NAME}} under the plan's step-therapy exception process.
Sincerely,
{{MEMBER_NAME}}Key points before you send it
- Document prior failure, intolerance, or contraindication to the step-therapy drug(s).
- Ask for an exception, not just an appeal — most plans have a formal exception pathway.
Want this pre-filled with your denial details?
Upload your letter — we'll parse it and generate this template with your facts, dates, and clinical evidence already in place.
Not legal or medical advice. This page is a self-help resource. You make your own decisions. Strip personal identifiers (name, date of birth, address, member ID) from any document before uploading or sharing. The information here summarizes commonly-published payer policies and federal rules; confirm against your specific plan document and the current denial letter before acting.