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.

Last verified: May 11, 2026

Alluma - Alluma Prior Authorization Request FormAlluma · Updated Apr 15, 2026
Amerigroup - Antiviral Agents Hepatitis C Texas Medicaid Prior Authorization Criteria Initial RequestAmerigroup · Updated Apr 15, 2026
Amerigroup - Hepatitis C SVR Reporting Prior Authorization Form AddendumAmerigroup · Updated Apr 15, 2026
Amerigroup - Antiviral Agents for Hepatitis C Virus Initial Authorization Request (Texas Medicaid)Amerigroup · Updated Apr 15, 2026
Amerigroup - Hepatitis C Treatments Prior Authorization of Benefits Form (Iowa)Amerigroup · Updated Apr 15, 2026
Amerigroup - TX Hepatitis C AgentsAmerigroup · Updated May 10, 2026

ICD-10 codes for Epclusa Prior Authorizations

B18.2Chronic viral hepatitis C

Support for Getting Your Patient on Epclusa

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