Otezla 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

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 11, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 11, 2026
California - Uniform Prior Authorization FormCalifornia · Updated May 16, 2026
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 11, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated May 11, 2026
Colorado - Uniform Prior Authorization FormColorado · Updated May 16, 2026

ICD-10 codes for Otezla Prior Authorizations

L40.50Arthropathic psoriasis, unspecified
L40.51Arthropathic psoriasis, seropositive
L40.52Arthropathic psoriasis, seronegative
L40.53Arthropathic psoriasis, other
L40.0Psoriasis vulgaris
L40.9Psoriasis, unspecified
M35.2Behçet disease

Appeal Templates

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

Brand Resources

Pharmacy List Pharmacy List resource
Billing and Coding Guide Billing and Coding Guide resource
Prior Authorization Checklist Prior Authorization Checklist resource
Prior Authorization Checklist: PsAPrior Authorization Checklist: PsA resource
Amgen Support Benefit Verification FormAmgen Support Benefit Verification Form resource
Otezla Start Form (For Specialty Pharmacy Only)Otezla Start Form (For Specialty Pharmacy Only) resource

Support for Getting Your Patient on Otezla

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.