HCV DAA Treatment Appeal Letters
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HCV DAA Treatment Appeal Letters

The template letters below are offered to help with challenging health plan coverage denials of Direct- Acting Antivirals Agents. The letters may be downloaded and modified for submission to health insurers.

Acknowledgements: Thank you to Kris Kowdley, MD with Swedish Medical Center for contributing the draft template letters.

Denial Appeal - GT1 Naive 12 Wk Treatment With ViekiraPak and Riba for Cirrhotic INF Contraindicated Patient.docx

Denial Appeal - GT1 8-Week Sovaldi for INF Contraindicated Patient.docx

Denial Appeal - GT1 Harvoni Re-Treate Post Sofosbuvir and Ribavirin Relapse.docx

Denial Appeal - GT2 Re-Treat with Sovaldi and Riba Post INF-Riba Fail.docx

Denial Appeal - GT3 Naive 12 Wk Treatment With Daklinza-Sovaldi.docx

Denial Appeal - Generic GT3 Naive 12 wks F0-2 DacSof.docx

Denial Appeal - GT1 12-24-Week Harvoni and Riba for decompensated INF Contraindicated Patient.docx