Pradaxa 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 Blue Shield of South Carolina - Pradaxa Prior Authorization Form Blue Cross Blue Shield of South Carolina · Updated May 16, 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

ICD-10 codes for Pradaxa Prior Authorizations

I48.91Unspecified atrial fibrillation
I82.90Acute embolism and thrombosis of unspecified vein
I82.401Acute embolism and thrombosis of unspecified deep veins of right lower extremity
I26.9Pulmonary embolism without acute cor pulmonale

Brand Resources

Formulary Coverage Formulary Coverage resource

Support for Getting Your Patient on Pradaxa

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.