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

ICD-10 codes for Praluent Prior Authorizations

I21.9Acute myocardial infarction, unspecified
I25.9Chronic ischemic heart disease, unspecified
I63.9Cerebral infarction, unspecified
I20.0Unstable angina
E78.0Pure hypercholesterolemia
E78.01Familial hypercholesterolemia

Support for Getting Your Patient on Praluent

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