Alphagan P Prior Authorization Resources

Find the right PA form for your patient's payer, get the ICD-10 codes you need, and download appeal templates — all in one place.

Last verified: May 11, 2026

Anthem Indiana Medicaid - Indiana Medicaid Pharmacy Prior Authorization FormAnthem Indiana Medicaid · Updated May 10, 2026
Anthem, Inc. - Prescription Drug Prior Authorization or Step Therapy Exception Request FormAnthem, Inc. · Updated May 12, 2026
Anthem, Inc. - Cal MediConnect Plan Pharmacy Prior Authorization FormAnthem, Inc. · Updated May 09, 2026
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 11, 2026
Blue Cross Blue Shield of Illinois - HCSC Illinois Uniform Prior Authorization FormBlue Cross Blue Shield of Illinois · Updated May 09, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 11, 2026

ICD-10 codes for Alphagan P Prior Authorizations

H40.11X0Primary open-angle glaucoma, right eye, stage unspecified
H40.12X0Primary open-angle glaucoma, left eye, stage unspecified
H40.13X0Primary open-angle glaucoma, bilateral, stage unspecified
H40.05Ocular hypertension

Brand Resources

Coverage Authorization Request Coverage Authorization Request resource

Support for Getting Your Patient on Alphagan P

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