This experience is designed to offer optimal performance on laptop and desktop computers. Certain features might not perform as intended on mobile devices.



Build a Letter of Medical Necessity

Empowering Patient Care: Personalized Letters of Medical Necessity

This platform is designed to streamline the process of creating comprehensive and persuasive letters of medical necessity for your patients, making it easier and more efficient for you to advocate for the care they need.

Select your healthcare plan and the type of letter you wish to create

Generate a
sample letter

Save the Letter of Medical Necessity to your desktop

Add protected health information and the prescriber’s signature

Submit to the patient’s insurance provider along with the required documents


Select a healthcare plan


Select the type of letter you wish to create

Generate a Sample Letter

Your letter is ready

Take a moment to read through the generated letter. Ensure all patient information, medical details, and supporting evidence accurately represent your patient’s needs. Send the letter to the relevant parties, such as insurance providers, healthcare organizations, or any other entity requiring the documentation for your patient’s care.

Download Now
Toggle ISI Open EXPAND


VILTEPSO is indicated for the treatment of Duchenne muscular dystrophy (DMD) in patients who have a confirmed mutation of the DMD gene that is amenable to exon 53 skipping. This indication is approved under accelerated approval based on an increase in dystrophin production in skeletal muscle observed in patients treated with VILTEPSO. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

For more information about VILTEPSO, see full Prescribing Information.

Important Safety Information

  • Warnings and Precautions: Kidney toxicity was observed in animals who received viltolarsen. Although kidney toxicity was not observed in the clinical studies with VILTEPSO, the clinical experience with VILTEPSO is limited, and kidney toxicity, including potentially fatal glomerulonephritis, has been observed after administration of some antisense oligonucleotides. Kidney function should be monitored in patients taking VILTEPSO. Serum creatinine may not be a reliable measure of kidney function in DMD patients.
  • Serum cystatin C, urine dipstick, and urine protein-to-creatinine ratio should be measured before starting VILTEPSO. Consider also measuring glomerular filtration rate before starting VILTEPSO. During treatment, monitor urine dipstick every month, and serum cystatin C and urine protein-to-creatinine ratio every three months.
  • Urine should be free of excreted VILTEPSO for monitoring of urine protein. Obtain urine either prior to VILTEPSO infusion, or at least 48 hours after the most recent infusion. Alternatively, use a laboratory test that does not use the reagent pyrogallol red, which has the potential to generate a false positive result due to cross reaction with any VILTEPSO in the urine. If a persistent increase in serum cystatin C or proteinuria is detected, refer to a pediatric nephrologist for further evaluation.
  • Adverse Reactions: The most common adverse reactions include upper respiratory tract infection, injection site reaction, cough, and pyrexia.
  • To report an adverse event, or for general inquiries, please call NS Pharma Medical Information at 1-866-NSPHARM (1-866-677-4276).

For more information about VILTEPSO, see full Prescribing Information.