Imbruvica 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.

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc.
California - Uniform Prior Authorization FormCalifornia
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc.
Cigna - General Medication Prior Authorization FormCigna Corporation
Colorado - Uniform Prior Authorization FormColorado

ICD-10 codes for Imbruvica Prior Authorizations

C91.10Chronic lymphocytic leukemia of B-cell type not in remission
C91.11Chronic lymphocytic leukemia of B-cell type in remission
C88.0Waldenström macroglobulinemia
D89.813Chronic graft-versus-host disease, unspecified
D89.810Chronic graft-versus-host disease of skin and subcutaneous tissue
D89.811Chronic graft-versus-host disease with skin involvement

Brand Resources

Pharmacy ListPharmacy List resource
How To Order ImbruvicaHow To Order Imbruvica resource
Billing & Coding Guide: WMBilling & Coding Guide: WM resource
Billing & Coding Guide: CLL/SLLBilling & Coding Guide: CLL/SLL resource
Billing & Coding Guide: cGVHDBilling & Coding Guide: cGVHD resource

Support for Getting Your Patient on Imbruvica

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