Eliquis 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: Apr 24, 2026

Amerigroup - Direct Oral Anticoagulants Prior Authorization RequestAmerigroup · Updated May 10, 2026
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated Apr 24, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated Apr 24, 2026
California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated Apr 24, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated Apr 24, 2026

ICD-10 codes for Eliquis Prior Authorizations

I48.0Paroxysmal atrial fibrillation
I48.1Persistent atrial fibrillation
I48.91Unspecified atrial fibrillation
I80.20Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities
I80.201Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity
I26.9Pulmonary embolism without acute cor pulmonale
I82.90Acute embolism and thrombosis of unspecified vein

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals Coverage Authorization Appeals resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Benefits Review FormForm for benefits investigation and prior auth
Formulary Coverage Formulary Coverage resource
Reimbursement InformationReimbursement Information resource
Coverage Authorization Request Coverage Authorization Request resource

Support for Getting Your Patient on Eliquis

Check coverage & formulary statusVerify PA requirements for your patient's plan.Find savings programsCopay cards, patient assistance, and more.Check medication interactionsScreen prescriptions for harmful drug combinations.