Trelegy Ellipta 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 Trelegy Ellipta Prior Authorizations

J44.9Chronic obstructive pulmonary disease, unspecified
J44.0Chronic obstructive pulmonary disease with (acute) lower respiratory infection
J44.1Chronic obstructive pulmonary disease with (acute) exacerbation
J45.9Other and unspecified asthma
J45.90Unspecified asthma
J45.901Unspecified asthma with (acute) exacerbation

Brand Resources

Formulary InformationFormulary Information resource

Support for Getting Your Patient on Trelegy Ellipta

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