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Cotellic [cotellic + zelboraf]
Prior Authorization Forms
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Cotellic [Cotellic + Zelboraf] Prior Authorization Resources
Get the latest prior authorization forms for Medicare, Medicaid, and commercial plans, as well as state and medication-specific forms.
Brand Resources
Reimbursement Information
Reimbursement Information resource
Pharmacy List
Pharmacy List resource
How to Order Cotellic
How to Order Cotellic resource
Coverage Authorization Appeals
Coverage Authorization Appeals resource
Letter of Medical Necessity
Letter of Medical Necessity resource
Patient Consent Form
Patient Consent Form resource
Patient Consent Form - Spanish
Patient Consent Form - Spanish resource
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Prior Authorization Forms
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California
Last verified: Dec 30, 2025
California - Uniform Prior Authorization Form
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Colorado
Last verified: Dec 30, 2025
Colorado - Uniform Prior Authorization Form
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Illinois
Last verified: Dec 30, 2025
Illinois - Uniform Prior Authorization Form
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Indiana
Last verified: Dec 30, 2025
Indiana - Uniform Prior Authorization Form
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Louisiana
Last verified: Dec 30, 2025
Louisiana - Uniform Prior Authorization Form
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Minnesota
Last verified: Dec 30, 2025
Minnesota - Uniform Prior Authorization Form
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Oregon
Last verified: Dec 30, 2025
Oregon - Uniform Prior Authorization Form
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Texas
Last verified: Dec 30, 2025
Texas - Uniform Prior Authorization Form
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Washington
Last verified: Dec 30, 2025
Washington - Uniform Prior Authorization Form
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Wisconsin
Last verified: Dec 30, 2025
Wisconsin - Uniform Prior Authorization Form
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See approval requirements for your carrier
Find out what types of documentation and step therapies this carrier may require for coverage.
Check coverage