Your CGRP appeal turns on the paperwork, not the pain.
The denial says step therapy. Our free letter builder maps your preventive history and migraine-day count onto the criteria a reviewer actually checks.
It arrives mid-cycle, in an envelope or a portal message you open between a triptan and the postdrome that follows, and it says some version of the same thing: not yet, not until you have tried and failed the cheaper preventives first. You already know those older preventives. You know the weight, the fog, the months lost to titration. The CGRP treatment your neurologist actually wants you on is sitting behind a wall called prior authorization, and the wall is made of paperwork. So you are going to file an appeal this week, probably tired, probably still photophobic, and the quality of that appeal will come down to how well the documentation is organized. That is the part we can help with, and we built a free tool to do exactly that.
The appeal turns on the paper trail, not the suffering
The mistake almost everyone makes is assuming the appeal turns on how bad the migraines are. Reviewers do not read pain. They read criteria. An appeal that names the specific preventives tried, how long each was taken, the documented outcome, the monthly migraine-day count, and the functional impact, all stated in the insurer's own vocabulary, clears review faster than three paragraphs about how much it hurts. We call it a letter builder, but what it actually builds is a structured record that maps your history onto the boxes a reviewer is already checking. The suffering is real. It is just not what gets the denial overturned. And when appeals for CGRP preventives are denied, the ones that succeed at the next level tend to share a common feature: they speak the plan's language back to the plan.
Why 'just appeal it' is not advice
The standard guidance is some version of call your doctor and file an appeal. That assumes the documentation is already assembled and you have the language to frame it. Most people have neither, because the history is scattered across years and across apps that stopped recording at the headache. This is the category pattern worth naming: most migraine trackers log the attack and then go quiet, so when an insurer asks for a two-year record of preventive failures and migraine-day frequency, you are reconstructing it from memory at the worst possible time. The appeal is winnable. The problem is that nobody handed you the record in a shape an insurer accepts.
What you enter, and why each field matters
The builder asks five things, and each one maps to something a reviewer looks for. One, which CGRP treatment was denied, whether a monoclonal antibody or an oral gepant, so the letter uses the right class language. Two, the preventives you have already tried, with an outcome for each (no effect, intolerable side effects, or partial response), because step-therapy denials are answered with a documented failure history, not a list of names. Three, your monthly migraine-day count over the last three months, the number that establishes burden. Four, how the condition affects work and daily function, in concrete terms (missed or reduced workdays, tasks you cannot do during the 24-to-72-hour postdrome). Five, the exact reason printed on your denial, so the letter answers that criterion directly instead of arguing in general. Nothing you type leaves your browser, and you do not need an account.
What it gives you back
The output is a complete letter, yours to copy, print, hand to your prescriber, or attach to the appeal. A real one reads close to this: a reconsideration request referencing the denial date and authorization number; a preventive history line such as topiramate (eight months, discontinued for cognitive side effects), propranolol (six months, no reduction in monthly migraine days), amitriptyline (four months, partial response, discontinued for daytime sedation); a current-burden line citing fifteen or more migraine days per month with residual photophobia and cognitive fog extending past each attack; and a functional-impact line in workday terms. Underneath, a short checklist of what to attach. It is plain, specific, and built to be read in ninety seconds by someone with a checklist.
Why a migraine app is building insurance paperwork
We built Postdrome because of migraines in our lives, and because every app we tried failed the people we love in the same way: it stopped at the headache. The attack was the only thing it recorded, and then it went quiet for the 24 to 72 hours of fatigue, brain fog, and residual photophobia that follow. The strange thing is that the record those apps never kept is the same record an insurer demands: a continuous, dated history of attacks, preventives, and how the whole thing actually affects a life. This prior-auth builder is free and stands on its own. It is also a small preview of the thing we kept wishing existed, the one that does not look away when the headache ends.
Postdrome opens for iPhone soon: continuous-symptom tracking through the full postdrome, an aura mode you can use when you cannot see straight, on-device privacy, and one lifetime price with nothing hidden. Add your name and we will tell you the day it goes live.
We cannot change your insurer's review criteria, and we will not pretend the appeal process is fair. What we can do is make sure your letter meets the criteria on the first pass: the right class language, a documented preventive-failure history, your migraine-day count, and the functional impact, all aimed at the exact reason on your denial. The builder is free, runs in your browser, stores nothing you enter, and asks for no account or email. It is built by the team behind Postdrome, the continuous migraine tracker launching for iPhone soon.
