Taltz 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

Anthem Amerigroup - Taltz Prior Authorization Form Anthem, Inc. · Updated Apr 16, 2026
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated Apr 24, 2026
Medicare Plus Blue and BCN Advantage of Michigan - Global PA FormBlue Cross Blue Shield of Michigan · Updated May 10, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated Apr 24, 2026
Blue Cross of Idaho - Medicare Part B Pharmacy Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated Apr 16, 2026
California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026

ICD-10 codes for Taltz Prior Authorizations

L40.0Psoriasis vulgaris
L40.50Arthropathic psoriasis, unspecified
M45.9Ankylosing spondylitis of unspecified sites in spine
M46.9Unspecified inflammatory spondylopathy

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals Letter TemplatePre-written appeals letter for denied PAs. Use when insurance denies Taltz coverage to support reconsideration request.
Letter of Medical Necessity TemplateLON template for PA submissions. Documents clinical rationale for Taltz therapy in PsO, PsA, AS, or nr-axSpA patients.
Appeals Letter Template (Editable PDF)Fillable appeals letter for customized PA denials. Edit directly in PDF for patient-specific appeal submissions.
Letter of Medical Necessity (Editable PDF)Fillable LON for patient-specific PA requests. Customize clinical justification and diagnosis details directly in PDF.
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Prior Authorization Resource GuideComprehensive PA guide with ICD-10 codes, dosing requirements, submission instructions via CoverMyMeds or Lilly Support Services.
Formulary Access Leave-Behind GuideQuick reference for formulary positioning, coverage policies, and access pathways. Use in payer discussions.

Support for Getting Your Patient on Taltz

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.