Fabhalta 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 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
Colorado - Uniform Prior Authorization FormColorado

ICD-10 codes for Fabhalta Prior Authorizations

D59.5Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]
N06.AIsolated proteinuria with C3 glomerulonephritis
N04.ANephrotic syndrome with C3 glomerulonephritis
N03.AChronic nephritic syndrome with C3 glomerulonephritis
N05.AUnspecified nephritic syndrome with C3 glomerulonephritis
N02.ARecurrent and persistent hematuria with C3 glomerulonephritis
N00.AAcute nephritic syndrome with C3 glomerulonephritis
N07.AHereditary nephropathy, not elsewhere classified with C3 glomerulonephritis
N01.ARapidly progressive nephritic syndrome with C3 glomerulonephritis
N06.6Isolated proteinuria with dense deposit disease
N04.6Nephrotic syndrome with dense deposit disease

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals: PNHCoverage Authorization Appeals: PNH resource
Letter of Medical Necessity: PNHLetter of Medical Necessity: PNH resource
PA & Appeals Kit: PNHPA & Appeals Kit: PNH resource
Coverage Authorization Appeals: IgANCoverage Authorization Appeals: IgAN resource
Letter of Medical Necessity: IgANLetter of Medical Necessity: IgAN resource
PA & Appeals Kit: IgANPA & Appeals Kit: IgAN resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Pharmacy List Pharmacy List resource
Coverage Authorization Request: PNHCoverage Authorization Request: PNH resource
Coverage Authorization Request: IgANCoverage Authorization Request: IgAN resource

Support for Getting Your Patient on Fabhalta

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.