Sabril 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 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

Colorado - Uniform Prior Authorization FormColorado · Updated Apr 16, 2026

ICD-10 codes for Sabril Prior Authorizations

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

G40.211Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus

G40.219Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus

G40.82Epileptic spasms

G40.823Epileptic spasms, intractable, with status epilepticus

G40.824Epileptic spasms, intractable, without status epilepticus

Brand Resources

Sabril Prescription Form - For Dispensing Through Lundbeck's SharePlus Program Sabril Prescription Form - For Dispensing Through Lundbeck's SharePlus Program resource

Support for Getting Your Patient on Sabril

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