Bosulif 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

Amerigroup - Pharmacy Prior Authorization CriteriaAmerigroup · Updated May 10, 2026
Amerigroup - Bosulif (bosutinib) Prior Authorization CriteriaAmerigroup · 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 Illinois - Rx Utilization Management Program Clinical Criteria IllinoisBlue Cross Blue Shield of Illinois · Updated May 10, 2026
Blue Cross Blue Shield of Michigan - Medicare Plus Blue Group PPO Essential Prior Authorization/Step Therapy ProgramBlue Cross Blue Shield of Michigan · Updated May 10, 2026
Blue Cross Blue Shield of Michigan - Medicare Plus Blue Group PPO Prior Authorization Step Therapy Program 2025 Healthy ValueBlue Cross Blue Shield of Michigan · Updated May 10, 2026

ICD-10 codes for Bosulif Prior Authorizations

C92.10Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.11Chronic myeloid leukemia, BCR/ABL-positive, in remission
C92.12Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.1Chronic myeloid leukemia, BCR/ABL-positive

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization AppealCoverage Authorization Appeal resource
Letter of Medical NecessityLetter of Medical Necessity resource
Formulary Exception LetterFormulary Exception Letter resource
Appeals Checklist Appeals Checklist resource
Appeals Checklsit Appeals Checklsit resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Pharmacy List Pharmacy List resource
Reimbursement Information Reimbursement Information resource
PA Checklist PA Checklist resource

Support for Getting Your Patient on Bosulif

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.