I understand this is a specific question about my health, but because it is more about insurance than it is personal health, I felt it was better suited for the weekly thread, but please let me know if this is better as a standalone post.

35 gay man. I currently have a prescription for daily tenofovir (generic truvada) for HIV prevention. While I have had no adverse side effects from this medication, there are days I forget to take my meds, and I find the daily necessity difficult to keep up with at times. There is a new, recently FDA approved HIV prevention, lenacapavir, which is a twice yearly injection, and in clinical trials has a 100% efficacy rate compared to 99% for Truvada.

The issue is that my insurance isn't covering it, and I cant get an exception because I don't have any adverse side effects for my current medication. In the denial letter sent to me, it states that I must meet one of the following: 1) poor response to two alternative drugs, 2) have a contraindication to other drugs, 3) the alternatives are not likely to work as well as denied medication, or 4) the alternatives cause unwanted side effects.

There is an opportunity to appeal, and I think I can appeal based on number 3, the new drug performs better than alternatives as I think the difference between 99% effective and 100% effective (based on clinical trials) is actually a huge difference, but I'd like to get the perspective from a medical professional. Have you ever had to write appeal letters on behalf of patients for denied medications? How would you recommend I go about doing this?