Gilenya 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 - Multiple Sclerosis Drugs Prior Authorization Form Cigna Corporation

ICD-10 codes for Gilenya Prior Authorizations

G35.10Relapsing remittent multiple sclerosis without mention of remission
G35.11Relapsing remittent multiple sclerosis with remission
G35.9Multiple sclerosis, unspecified
G35.0Optic neuritis
G35.40Secondary progressive multiple sclerosis without active disease
G35.41Secondary progressive multiple sclerosis with active disease

Support for Getting Your Patient on Gilenya

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.