DUR Statement Template
My name is XXX and I am a [patient/caregiver/loved one] who has spent XXX years [living/working with/caring for someone] with [disease]. [If relevant, add professional background.] I am asking you to support coverage for [treatment] without restrictions or barriers that would block access to patients who may benefit.
[Disease state] affects XXX people worldwide. According to data from [source], approximately XXX patients whose condition makes them amenable to this treatment live in our state. [Disease state] affects patients by… It is [chronic/fatal/debilitating] and typically results in… My personal experience with the disease is…
This treatment helps patients by… My personal experience with [treatment] is… It [has improved/would improve] my life by… Without access to this treatment, I would…
Clinical data shows that the treatment is effective. For example, according to [source], patients [were able to/didn’t have to]… My experience reflects… This treatment is [different from/complementary to/superior to] existing treatments because… This treatment is important to patients because…
Again, I ask that you support coverage for [treatment] according to the FDA label without requirements like [“fail first,” step therapy, invasive testing, and/or other requirements] that will limit patient access to this treatment.
Thank you for your consideration.