Myfembree 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.

Last verified: May 08, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 08, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 08, 2026
California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 08, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated May 08, 2026
Colorado - Uniform Prior Authorization FormColorado · Updated Apr 16, 2026

ICD-10 codes for Myfembree Prior Authorizations

D25.9Leiomyoma of uterus, unspecified
D25.1Intramural leiomyoma of uterus
N92.0Excessive and frequent menstruation with regular cycle
N92.1Excessive and frequent menstruation with irregular cycle
N80.9Endometriosis, unspecified
N80Endometriosis

Brand Resources

Formulary Information: Uterine FibroidsFormulary Information: Uterine Fibroids resource
Reimbursement InformationReimbursement Information resource

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