Qudexy XR 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 11, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 11, 2026

Blue Cross Blue Shield of North Carolina - Topiramate ER Prior Review Certification Faxback FormBlue Cross Blue Shield of North Carolina · Updated May 13, 2026

Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 11, 2026

California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026

CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 11, 2026

Cigna - General Medication Prior Authorization FormCigna Corporation · Updated May 11, 2026

ICD-10 codes for Qudexy XR Prior Authorizations

G40.1Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures

G40.2Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures

G40.3Generalized idiopathic epilepsy and epileptic syndromes

G40.4Other generalized epilepsy and epileptic syndromes

G43.0Migraine without aura

G43.9Migraine, unspecified

Support for Getting Your Patient on Qudexy XR

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