Epclusa 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.

Alluma - Alluma Prior Authorization Request FormAlluma
Amerigroup - Antiviral Agents Hepatitis C Texas Medicaid Prior Authorization Criteria Initial RequestAmerigroup
Amerigroup - Hepatitis C SVR Reporting Prior Authorization Form AddendumAmerigroup
Amerigroup - Antiviral Agents for Hepatitis C Virus Initial Authorization Request (Texas Medicaid)Amerigroup
Amerigroup - Hepatitis C Treatments Prior Authorization of Benefits Form (Iowa)Amerigroup
Amerigroup - TX Hepatitis C AgentsAmerigroup

ICD-10 codes for Epclusa Prior Authorizations

B18.2Chronic viral hepatitis C

Support for Getting Your Patient on Epclusa

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.