Zolgensma 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 Blue Shield of Kansas - Prior Authorization Form for High-Cost MedicationsBlue Cross and Blue Shield of Kansas
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

ICD-10 codes for Zolgensma Prior Authorizations

G12.9Spinal muscular atrophy, unspecified
G12.0Infantile spinal muscular atrophy, type I [Werdnig-Hoffman]

Brand Resources

Pharmacy List Pharmacy List resource
How to Order Zolgensma How to Order Zolgensma resource
Billing & Coding Guide Billing & Coding Guide resource

Support for Getting Your Patient on Zolgensma

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.