Cotellic [Cotellic + Zelboraf] 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 - Prior Authorization Form for Medical InjectablesAnthem, Inc. · Updated May 12, 2026
Anthem - Medical Injectables Prior AuthorizationAnthem, Inc. · Updated May 12, 2026
Anthem, Inc. - New York Medicaid Prior Authorization Form for Medical InjectablesAnthem, Inc. · Updated May 12, 2026
Anthem, Inc. - Prescription Drug Prior Authorization or Step Therapy Exception Request FormAnthem, Inc. · Updated May 12, 2026
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 11, 2026
Arkansas Blue Cross Blue Shield - Medicare Advantage Prior Authorization Request FormArkansas Blue Cross Blue Shield · Updated May 12, 2026

ICD-10 codes for Cotellic [Cotellic + Zelboraf] Prior Authorizations

C43.9Malignant melanoma of skin, unspecified
C79.89Secondary malignant neoplasm of other specified sites
C96.0Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis
C96.9Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified

Appeal Templates

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

Brand Resources

Reimbursement InformationReimbursement Information resource
Pharmacy List Pharmacy List resource
How to Order Cotellic How to Order Cotellic resource
Patient Consent Form Patient Consent Form resource
Patient Consent Form - SpanishPatient Consent Form - Spanish resource

Support for Getting Your Patient on Cotellic [Cotellic + Zelboraf]

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.