Eliquis 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.

Amerigroup - Direct Oral Anticoagulants Prior Authorization RequestAmerigroup
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.
Cigna - General Medication Prior Authorization FormCigna Corporation

ICD-10 codes for Eliquis Prior Authorizations

I48.0Paroxysmal atrial fibrillation
I48.1Persistent atrial fibrillation
I48.91Unspecified atrial fibrillation
I80.20Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities
I80.201Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity
I26.9Pulmonary embolism without acute cor pulmonale
I82.90Acute embolism and thrombosis of unspecified vein

Brand Resources

ELIQUIS 360 Benefits Review FormInsurance benefits verification form for ELIQUIS 360 Support. Submit to assess patient coverage, copay, and financial assistance eligibility.

Support for Getting Your Patient on Eliquis

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.