Donepezil Hydrochloride - Donepezil Hydrochloride tablet, Film Coated 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.

California - Uniform Prior Authorization FormCalifornia
Colorado - Uniform Prior Authorization FormColorado
Illinois - Uniform Prior Authorization FormIllinois
Indiana - Uniform Prior Authorization FormIndiana
Louisiana - Uniform Prior Authorization FormLouisiana
Minnesota - Uniform Prior Authorization FormMinnesota

ICD-10 codes for Donepezil Hydrochloride - Donepezil Hydrochloride tablet, Film Coated Prior Authorizations

G30.9Alzheimer's disease, unspecified
G30.0Alzheimer's disease with early onset
G30.1Alzheimer's disease with late onset
F02.80Dementia in other diseases classified elsewhere without behavioral disturbance
F02.81Dementia in other diseases classified elsewhere with behavioral disturbance

Support for Getting Your Patient on Donepezil Hydrochloride - Donepezil Hydrochloride tablet, Film Coated

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.