Vivitrol 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 Vivitrol Prior Authorizations

F10.20Alcohol dependence, uncomplicated
F11.20Opioid dependence, uncomplicated

Brand Resources

Formulary Information Formulary Information resource
Billing & Coding GuideBilling & Coding Guide resource
Buy & Bill GuideBuy & Bill Guide resource

Support for Getting Your Patient on Vivitrol

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