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doi: 10.1016/S0140-6736(64)90011-X [DOI] [PubMed] [Google Scholar] 6

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Appeal strategy: Document previous trials of required step medications under a prior insurance plan (requires records from previous provider) Request a step therapy exception based on medical contraindication to required step drugs (requires specific contraindication, not just "patient prefers Mounjaro") Demonstrate urgent clinical need (A1C above 10%, recent hospitalization for hyperglycemia, severe complications) If step therapy is truly incomplete, the fastest path is usually completing the required trial rather than appealing Success rate: 15% for step therapy exceptions without documented contraindication