Alphagan P 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.

Anthem Indiana Medicaid - Indiana Medicaid Pharmacy Prior Authorization FormAnthem Indiana Medicaid
Anthem, Inc. - Prescription Drug Prior Authorization or Step Therapy Exception Request FormAnthem, Inc.
Anthem, Inc. - Cal MediConnect Plan Pharmacy Prior Authorization FormAnthem, Inc.
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield
Blue Cross Blue Shield of Illinois - HCSC Illinois Uniform Prior Authorization FormBlue Cross Blue Shield of Illinois
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc.

ICD-10 codes for Alphagan P Prior Authorizations

H40.11X0Primary open-angle glaucoma, right eye, stage unspecified
H40.12X0Primary open-angle glaucoma, left eye, stage unspecified
H40.13X0Primary open-angle glaucoma, bilateral, stage unspecified
H40.05Ocular hypertension

Brand Resources

Coverage Authorization Request Coverage Authorization Request resource

Support for Getting Your Patient on Alphagan P

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.