Gilenya 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 - Multiple Sclerosis Drugs Prior Authorization Form Cigna Corporation · Updated May 16, 2026

ICD-10 codes for Gilenya Prior Authorizations

G35.10Relapsing remittent multiple sclerosis without mention of remission
G35.11Relapsing remittent multiple sclerosis with remission
G35.9Multiple sclerosis, unspecified
G35.0Optic neuritis
G35.40Secondary progressive multiple sclerosis without active disease
G35.41Secondary progressive multiple sclerosis with active disease

Support for Getting Your Patient on Gilenya

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