HyQvia 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 HyQvia Prior Authorizations

D83.9Common variable immunodeficiency, unspecified
D80.0Hereditary hypogammaglobulinemia
D82.0Wiskott-Aldrich syndrome
D81.9Combined immunodeficiency, unspecified
G61.81Chronic inflammatory demyelinating polyneuritis

Brand Resources

Pharmacy List Pharmacy List resource
How To Order HyQvia How To Order HyQvia resource

Support for Getting Your Patient on HyQvia

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.