Vyxeos 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 May 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
Cigna - Vyxeos Prior Authorization Form Cigna Corporation · Updated May 16, 2026

ICD-10 codes for Vyxeos Prior Authorizations

C92.90Myeloid leukemia, unspecified, not having achieved remission
C92.91Myeloid leukemia, unspecified in remission
C92.A0Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A1Acute myeloid leukemia with multilineage dysplasia, in remission

Brand Resources

Reimbursement InformationReimbursement Information resource
Coding GuideCoding Guide resource
How To Order VyxeosHow To Order Vyxeos resource

Support for Getting Your Patient on Vyxeos

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.