Prior Auth and Step Therapy Kit

Your doctor prescribed it. Your plan said "not yet," or "try this cheaper drug first." Now you are stuck between the office and the plan, and nobody will tell you when you will hear back.

Free copies available. Medical paperwork often lands when money is already stretched. That's not your fault. If paying isn't possible right now, email thedenialdesk@gmail.com with the subject "Free kit" and tell us which kit. You don't need to explain why. Please don't include medical details, diagnoses, bills or insurance numbers. Limit one free kit per email address.

Free updates: when a rule or date changes, your download link gets the updated file.

Plans have deadlines too, and many denials do not hold up. In 2024, about 81% of appealed Medicare Advantage prior authorization denials were fully or partly overturned (KFF analysis of 2024 data). Results vary. Only about 1 in 9 denials were appealed.

WHAT YOU GET

• Start here guide (PDF, 9 pages). How long your type of plan has to decide, the new Original Medicare approval rules in six states, how to get an urgent decision, the reasons that usually win a step therapy exception, what to do when a drug is not on the list, how to appeal, and a printable list of medicines you have tried.
• Letters (Word, opens in Google Docs). A prior auth appeal, an urgent request, a step therapy exception, a drug exception (not on the list, over a limit, or tier), an outside review request, and a support letter request for your doctor.
• Tracker (Excel, opens in Google Sheets). Pick your coverage and it shows when the plan's decision is due and your last day to appeal. Includes a "medicines I tried" log, the best evidence for a step therapy exception, and a call log.

WHO IT IS FOR

Anyone waiting on a prior authorization or fighting a step therapy rule: people with chronic conditions, caregivers, and parents. Works for job-based plans, HealthCare.gov plans, Medicare Advantage, Medicare drug plans, and Medicaid.

HOW IT WORKS

This is an instant digital download. Nothing will be shipped.

This kit is self-serve. It doesn't include personal help with your case. For free one-on-one help, see Who will help me for free?

The guide (PDF) reads fine on a phone. The letters and tracker are easiest on a computer, or open them free in Google Docs and Sheets.

SOURCES

- Medicare Advantage prior authorization denials and appeals, 2024 data: KFF, January 2026 (kff.org).

- Plan decision deadlines: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) and HealthCare.gov.

- Original Medicare WISeR model: CMS WISeR model page and FAQ (cms.gov).

PLEASE NOTE

This is general educational information, not legal or medical advice. Always follow the deadlines in your own plan's notices. The Denial Desk is not affiliated with any health plan, pharmacy benefit manager, or government agency. For personal use only.

AI disclosure: This kit was drafted with help from AI tools, then reviewed and fact-checked by our founder, a certified medical coding professional.