Rexulti 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
Colorado - Uniform Prior Authorization FormColorado · Updated May 16, 2026

ICD-10 codes for Rexulti Prior Authorizations

F32.9Major depressive disorder, single episode, unspecified
F33.9Major depressive disorder, recurrent, unspecified
F20.9Schizophrenia, unspecified
F20.0Paranoid schizophrenia
R45.1Restlessness and agitation

Brand Resources

Formulary Information: Major Depressive Disorder (MDD)Check formulary status and tier placement for REXULTI across major health plans to verify coverage for your patients.
Formulary Information: SchizophreniaCheck formulary status and tier placement for REXULTI across major health plans to verify coverage for your patients.
Formulary Information: Agitation Associated With Dementia Due to Alzheimer's DiseaseCheck formulary status and tier placement for REXULTI across major health plans to verify coverage for your patients.

Support for Getting Your Patient on Rexulti

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.