Gvoke HypoPen 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.

Anthem, Inc. - Prior Authorization Form for Medical InjectablesAnthem, Inc.
Anthem, Inc. - Medical Injectables Prior Authorization Form (Nevada Medicaid)Anthem, Inc.
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield
Blue Cross Blue Shield of Texas - Texas Standard Prior Authorization Request FormBlue Cross Blue Shield of Texas
Blue Cross Blue Shield of Texas - TXMC Prior Authorization Fax FormBlue Cross Blue Shield of Texas
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc.

ICD-10 codes for Gvoke HypoPen Prior Authorizations

E16.2Hypoglycemia, unspecified
E16.0Drug-induced hypoglycemia without coma
E16.A3Hypoglycemia level 3
E10.641Type 1 diabetes mellitus with hypoglycemia with coma
E10.649Type 1 diabetes mellitus with hypoglycemia without coma
E11.641Type 2 diabetes mellitus with hypoglycemia with coma
E11.649Type 2 diabetes mellitus with hypoglycemia without coma

Appeal Templates

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

Brand Resources

Letter of Medical ExceptionLetter of Medical Exception resource

Support for Getting Your Patient on Gvoke HypoPen

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.