Eylea HD 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.

Aetna Better Health - Eylea Medication Precertification RequestAetna Better Health
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield
ATRIO Health Plans - Ophthalmic VEGF Inhibitors Part B Step Therapy PA Request FormATRIO Health Plans, Inc.
ATRIO Health Plans, Inc. - Ophthalmic VEGF Inhibitors Part B Step Therapy Prior Authorization Request FormATRIO Health Plans, Inc.
Blue Cross Blue Shield of Michigan - Medication Authorization Request Form - AfliberceptBlue Cross Blue Shield of Michigan
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc.

ICD-10 codes for Eylea HD Prior Authorizations

H35.30Unspecified macular degeneration
H35.31Nonexudative age-related macular degeneration
H35.32Exudative age-related macular degeneration
E10.321Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E11.321Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E11.31Type 2 diabetes mellitus with unspecified diabetic retinopathy
E11.32Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy
E11.35Type 2 diabetes mellitus with proliferative diabetic retinopathy
E10.35Type 1 diabetes mellitus with proliferative diabetic retinopathy
H34.81Central retinal vein occlusion

Support for Getting Your Patient on Eylea HD

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.