Trokendi 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.

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
Colorado - Uniform Prior Authorization FormColorado

ICD-10 codes for Trokendi XR Prior Authorizations

G40.811Lennox-Gastaut syndrome, not intractable, with status epilepticus
G40.812Lennox-Gastaut syndrome, not intractable, without status epilepticus
G43.009Migraine without aura, not intractable, with status migrainosus
G43.109Migraine with aura, not intractable, without status migrainosus

Brand Resources

Reimbursement InformationReimbursement Information resource
Coverage Authorization Request Coverage Authorization Request resource

Support for Getting Your Patient on Trokendi XR

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