Direct-acting Antiviral (DAA) Prior Authorization Letter Templates | AIDS Education and Training Centers National Coordinating Resource Center (AETC NCRC)

Publish date:

June 10, 2020

AETC Source

AETC National Coordinating Resource Center,

South Central AETC,

Northeast/Caribbean AETC,

National Clinician Consultation Center,

New England AETC,

Southeast AETC,

MidAtlantic AETC

Non-AETC Source

Georgia Department of Health

The AETC HIV Comorbidity Community of Practice and Learning has developed three generic (no specific pharmaceuticals identified) template letters for healthcare providers to use for prior authorization requests of DAAs. The templates include common scenarios for which national guidelines recommend immediate treatment - a person who is symptomatic, a person who is asymptomatic but co-infected with HIV, and a person with an active substance user disorder. These templates can be customized and modified by the user.