Tremfya 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: Apr 24, 2026

Amerigroup - Tremfya Prior Authorization Form Anthem, Inc. · Updated Apr 16, 2026
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated Apr 24, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated Apr 24, 2026
California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated Apr 24, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated Apr 24, 2026

ICD-10 codes for Tremfya Prior Authorizations

L40.9Psoriasis, unspecified
L40.50Arthropathic psoriasis, unspecified
K51.90Ulcerative colitis, unspecified, without complications
K50.90Crohn's disease, unspecified, without complications

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals: Plaque PsoriasisCoverage Authorization Appeals: Plaque Psoriasis resource
Letter of Medical Necessity: Plaque PsoriasisLetter of Medical Necessity: Plaque Psoriasis resource
Coverage Authorization Appeals: Psoriatic ArthritisCoverage Authorization Appeals: Psoriatic Arthritis resource
Letter of Medical Necessity: Psoriatic ArthritisLetter of Medical Necessity: Psoriatic Arthritis resource
Coverage Authorization Appeals: Ulcerative ColitisCoverage Authorization Appeals: Ulcerative Colitis resource
Letter of Medical Necessity: Ulcerative ColitisLetter of Medical Necessity: Ulcerative Colitis resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Pharmacy List Pharmacy List resource
Formulary Coverage: Plaque PsoriasisFormulary Coverage: Plaque Psoriasis resource
Formulary Coverage: Psoriatic Arthritis Formulary Coverage: Psoriatic Arthritis resource
Field Reimbursement ManagerField Reimbursement Manager resource
Prior Authorization Checklist: Plaque PsoriasisPrior Authorization Checklist: Plaque Psoriasis resource
Letter of Exception: Plaque PsoriasisLetter of Exception: Plaque Psoriasis resource
Prior Authorization Checklist: Psoriatic ArthritisPrior Authorization Checklist: Psoriatic Arthritis resource
Letter of Exception: Psoriatic ArthritisLetter of Exception: Psoriatic Arthritis resource
Prior Authorization Checklist: Ulcerative ColitisPrior Authorization Checklist: Ulcerative Colitis resource
Letter of Exception: Ulcerative ColitisLetter of Exception: Ulcerative Colitis resource

Support for Getting Your Patient on Tremfya

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.