[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-279707-105":53,"doc-detail-279707-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","letter-of-medical-necessity-otezla-apremilast","Letter of Medical Necessity - Otezla（apremilast）","","Guide for preparing a Letter of Medical Necessity to support an appeal for coverage of Otezla® (apremilast) when a plan requires documentation alongside an appeal letter. Covers the letter’s purpose, required patient and insurance details, clinical justification elements such as diagnosis, severity, prior therapies, and why formulary-preferred options are unsuitable. Includes a checklist and a sample letter template, plus key safety information and indications for Otezla.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/letter-of-medical-necessity-otezla-apremilast/279707/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/letter-of-medical-necessity-otezla-apremilast/279707.png","ImageObject",442,249,{"name":88,"@type":89},"Dipper","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"When is a Letter of Medical Necessity required in the Otezla coverage process?","Question",{"text":109,"@type":110},"Many plans require it to accompany an Appeal Letter supporting the choice of Otezla over other formulary agents. The letter explains the medical rationale for prescribing the drug.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What information should be included in the Letter of Medical Necessity checklist?",{"text":114,"@type":110},"Include the patient’s name, policy number, and date of birth; support for the recommendation (history, diagnosis, current condition, and relevant medical records); documentation of severity (including photos); prior therapies with durations and discontinuation reasons; and clinical support for why preferred formulary agents are not appropriate.",{"name":116,"@type":107,"acceptedAnswer":117},"What clinical elements are emphasized in the sample letter template?",{"text":118,"@type":110},"The template requests patient history and current condition, brief recent symptoms and severity description (including BSA% when applicable), prior therapies and responses, professional opinion with prognosis, clinical rationale supporting use of Otezla, and contact information for follow-up.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},279707,1790220749,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":76},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","COMPOSING A LETTER OF MEDICAL NECESSITY  \nThis guide is for informational purposes only. It is not intended to provide reimbursement or legal advice. Individual health plans’ policies concerning reimbursement are complex and frequently VIZMWIH􀀒 8LIVIJSVI􀀐 TPIEWI GSRXEGX XLMVH􀀑TEVX] TE]IVW JSV WTIGMʗG MRJSVQEXMSR SR GSZIVEKI TSPMGMIW􀀒 For more information, please call Otezla SupportPlus™ at 1-844-4OTEZLA (1-844-468-3952) .  \nMany plans require a Letter of Medical Necessity to accompany an Appeal Letter supporting the choice of Otezla® (apremilast) over other agents that are on the formulary. The purpose of the letter is to explain the rationale for the drug.* The following resource provides information to help in the process of writing a Letter of Medical Necessity, including the checklist below and a sample letter.  \nChecklist  \nThis checklist can help ensure all relevant information is included in the Letter of Medical Necessity:  \nPatient’s name, policy number, and date of birth  \nSupport for recommending Otezla (patient history, diagnosis, and current condition; include relevant medical records and history of infections, allergies, and existing comorbidities)  \nDocumentation of severity of condition (include photos)  \nList of previous therapies and duration of treatment, including explanation of why each therapy was discontinued  \nExplanation of why formulary-preferred agents are not appropriate and clinical support for your recommendation (this clinical trial data can be from the Otezla package insert)  \n* For Medicare beneficiaries, there are specific requirements that need to be met for the HCP to be considered a legal representative of the patient in an appeal. For additional information, please visit:  \n[https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Parts-C-and-D-Enrollee-Grievances-Organization-Coverage](https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Parts-C-and-D-Enrollee-Grievances-Organization-Coverage)- Determinations-and-Appeals-Guidance.pdf.  \nINDICATIONS  \nOtezla® (apremilast) is indicated for the treatment of adult patients with plaque psoriasis who are candidates for phototherapy or systemic therapy.  \nOtezla is indicated for the treatment of adult patients with active psoriatic arthritis.  \nOtezla is indicated for the treatment of adult patients with oral ulcers associated with Behçet’s Disease.  \nIMPORTANT SAFETY INFORMATION  \nContraindications  \n• Otezla is contraindicated in patients with a known hypersensitivity toapremilast or to any of the excipients in the formulation  \nPlease see additional Important Safety Information on the last two pages.  \nSample Letter of Medical Necessity  \n Otezla® (apremilast) Letter Of Medical Necessity   \nMedical director Insurance company  \nAddress  \nPatient name Policy number  \nDate of birth  \nPhysician’s Request for Review:  \n Peer-to-peer review requested (same or like specialty)  Other   \nDear  \nI am writing to provide additional information to support my request for the treatment of  with Otezla® (apremilast) for Primary  \nDiagnosis/ICD-10-CM Code:  \n L40.50 (Arthropathic psoriasis, unspecified)  \n L40.51 (Distal interphalangealpsoriatic arthropathy)  \n L40.52 (Psoriatic arthritis mutilans)  \n L40.53 (Psoriatic spondylitis)  \n L40.59 (Other psoriatic arthropathy)  \nL40.0 (Psoriasis vulgaris)  \n%BSA Affected  \nL40.8 (Other psoriasis)  \n%BSA Affected  L40.9 (Psoriasis, unspecified)  \n%BSA Affected  M35.2 (Behçet’s Disease)  \nIn brief, treating with Otezla is medically appropriate and necessary and should be covered and reimbursed. Below , this letter outlines the medical history, prognosis and treatment rationale for .  \nSummary of Patient History:  \n[Note: Exercise your medical judgment and discretion when providing a diagnosis and characterization of the patient’s medical condition.]  \nPatient’s history, diagnosis, and current condition:  \nSTEP 1.  \nInclude the patient information  \nSTEP 2.  \nProvide the information relevant ","cbCais75bzV8TIdn","https://ap.wps.com/l/cbCais75bzV8TIdn","pdf",267411,7,"English","# Composing a Letter of Medical Necessity\n## Checklist for Required Information\n## Indications\n## Important Safety Information\n## Sample Letter of Medical Necessity","[{\"question\":\"When is a Letter of Medical Necessity required in the Otezla coverage process?\",\"answer\":\"Many plans require it to accompany an Appeal Letter supporting the choice of Otezla over other formulary agents. The letter explains the medical rationale for prescribing the drug.\"},{\"question\":\"What information should be included in the Letter of Medical Necessity checklist?\",\"answer\":\"Include the patient’s name, policy number, and date of birth; support for the recommendation (history, diagnosis, current condition, and relevant medical records); documentation of severity (including photos); prior therapies with durations and discontinuation reasons; and clinical support for why preferred formulary agents are not appropriate.\"},{\"question\":\"What clinical elements are emphasized in the sample letter template?\",\"answer\":\"The template requests patient history and current condition, brief recent symptoms and severity description (including BSA% when applicable), prior therapies and responses, professional opinion with prognosis, clinical rationale supporting use of Otezla, and contact information for follow-up.\"}]","Letter of Medical Necessity - Otezla（apremilast） | PDF",1789525834]