Caplyta 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.
Caterpillar Prescription Drug Benefit - Prior Authorization Request FormCaterpillar Prescription Drug Benefit
Cigna - General Medication Prior Authorization FormCigna Corporation

ICD-10 codes for Caplyta Prior Authorizations

F20.0Paranoid schizophrenia
F20.1Disorganized schizophrenia
F20.9Schizophrenia, unspecified
F31.10Bipolar disorder, current episode manic without psychotic features, unspecified
F31.9Bipolar disorder, unspecified
F32.0Major depressive disorder, single episode, mild
F32.9Major depressive disorder, single episode, unspecified
F33.9Major depressive disorder, recurrent, unspecified

Brand Resources

Formulary InformationFormulary Information resource
Coverage Authorization Request Coverage Authorization Request resource
Prior Authorization GuidePrior Authorization Guide resource
Pharmacy Callback Guide Pharmacy Callback Guide resource

Support for Getting Your Patient on Caplyta

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