Epidiolex 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.

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
Cigna - Epidiolex Prior Authorization FormCigna Corporation

ICD-10 codes for Epidiolex Prior Authorizations

G40.81Lennox-Gastaut syndrome
G40.811Lennox-Gastaut syndrome, not intractable, with status epilepticus
G40.812Lennox-Gastaut syndrome, not intractable, without status epilepticus
G40.813Lennox-Gastaut syndrome, intractable, with status epilepticus
G40.814Lennox-Gastaut syndrome, intractable, without status epilepticus
G40.83Dravet syndrome
G40.833Dravet syndrome, intractable, with status epilepticus
G40.834Dravet syndrome, intractable, without status epilepticus
Q85.1Tuberous sclerosis

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
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

Pharmacy List Pharmacy List resource
Reimbursement Information Reimbursement Information resource
Formulary InformationFormulary Information resource
Letter of Medical ExceptionLetter of Medical Exception resource

Support for Getting Your Patient on Epidiolex

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.