Alecensa 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

Amerigroup - PHARM ALL AlecensaAmerigroup · Updated May 10, 2026
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 11, 2026
Blue Cross Blue Shield of North Carolina - Medicare Prior Authorization Enhanced Criteria 2026Blue Cross Blue Shield of North Carolina · Updated May 10, 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

ICD-10 codes for Alecensa Prior Authorizations

C34.90Unspecified malignant neoplasm of unspecified part of unspecified side of lung
C34.00Unspecified malignant neoplasm of unspecified part of right main bronchus and left main bronchus
C34.10Unspecified malignant neoplasm of unspecified part of left main bronchus

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization AppealsCoverage Authorization Appeals resource
Letter of Medical Necessity Letter of Medical Necessity resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Reimbursement InformationReimbursement Information resource
Pharmacy ListPharmacy List resource
How To Order AlecensaHow To Order Alecensa resource
Billing and Coding Guide Billing and Coding Guide resource

Support for Getting Your Patient on Alecensa

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.