Letter of Medical Necessity for NormaLyte

Some dysautonomia patients use NormaLyte as a way to supplement their salt and fluid intake. NormaLyte comes in several flavors and a plain flavor developed with the input of Dysautonomia International and over 1000 dysautonomia patients, called PURE. It’s an electrolyte powder you can add to water. Some people like to add a splash of their favorite flavor juice, like OJ or cranberry juice to give it a little flavor. NormaLyte generously donates 10% of sales from PURE to Dysautonomia International to support our research, physician education, public awareness and patient empowerment programs.

Some insurance companies may reimburse you for the cost of NormaLyte with a prescription from your doctor because it is considered a Medical Food Product approved by the FDA. This Letter of Medical Necessity Template may be helpful in persuading your insurance company to pay for it. Call your insurance company to see if Medical Food Products are covered by your plan when you have a prescription and a letter of medical necessity from your doctor. Then ask your doctor to fill it out. The doctor can change the letter as needed for your specific situation.


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