Gammaplex 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 - Intravenous Immune Globulin (IVIG) -SCIG Prior Authorization Form Cigna Corporation

ICD-10 codes for Gammaplex Prior Authorizations

D80.9Immunodeficiency with predominantly antibody defects, unspecified
D80.0Hereditary hypogammaglobulinemia
D82.0Wiskott-Aldrich syndrome
D81.9Combined immunodeficiency, unspecified
D69.3Immune thrombocytopenic purpura

Brand Resources

Reimbursement Information Reimbursement Information resource
Get Benefits Investigation Support Get Benefits Investigation Support resource

Support for Getting Your Patient on Gammaplex

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