Adcirca 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

Anthem Indiana Medicaid - Request for Prior Authorization Pulmonary Hypertensives Indiana Anthem MedicaidAnthem Indiana Medicaid · Updated May 10, 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 Minnesota - Oral PAH Agents Prior Authorization with Quantity Limit Program SummaryBlue Cross Blue Shield of Minnesota · Updated May 10, 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 Apr 16, 2026

CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 11, 2026

ICD-10 codes for Adcirca Prior Authorizations

I27.0Primary pulmonary hypertension

Brand Resources

Pharmacy List Pharmacy List resource

ASSIST Request Form ASSIST Request Form resource

Support for Getting Your Patient on Adcirca

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