Express Scripts Letter of Medical Necessity Guide
How to write an LMN and overturn a prior authorization denial with Express Scripts. Includes denial reasons, turnaround times, appeals address, and clinician tips.
Quick Facts
- Avg Turnaround: 72h standard, 24h expedited
- Appeals Address: Express Scripts Appeals, PO Box 66588, St. Louis, MO 63166
- Provider Portal: https://www.express-scripts.com/
Why ESI Denies Prior Authorizations
- 1. Not on National Preferred Formulary
- 2. Step therapy
- 3. Dose optimization
Clinician Tips for ESI
- ✓ ESI manages Cigna and many employer plans
- ✓ Accredo is ESI specialty pharmacy
- ✓ Submit PA via CoverMyMeds or Surescripts
PBM owned by Cigna. Accredo dispenses specialty meds.
ESI Prior Authorization FAQ
Why does ESI deny prior authorizations?
The most common ESI denial reasons are: Not on National Preferred Formulary; Step therapy; Dose optimization.
How long does ESI take to review a prior authorization?
ESI typically responds in 72h standard, 24h expedited.
What should a Letter of Medical Necessity for ESI include?
An LMN for Express Scripts should reference the specific medical policy or coverage bulletin, document failed first-line therapies with dates, include current labs and ICD-10 codes, and cite supporting clinical guidelines. PBM owned by Cigna. Accredo dispenses specialty meds.