support they need with the Patient
Assistance Program and $0 copay
for those eligible
Sample Letter Template: Medical Necessity
KEVZARA sample letters are included to help provide the type of information that may be useful when responding to a health plan. These letters provide an example of the types of information that may be provided when responding to a request from a patient’s health plan to provide either a letter of appeal or a letter of medical necessity for KEVZARA. Use of the information in these letters does not guarantee that the health plan will cover KEVZARA and is not intended to be a substitute for or an influence on the independent medical judgment of the physician.