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: Apr 24, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated Apr 24, 2026

Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated Apr 24, 2026

California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026

CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated Apr 24, 2026

Cigna - General Medication Prior Authorization FormCigna Corporation · Updated Apr 24, 2026

Cigna - Praluent Prior Authorization Form Cigna Corporation · Updated Apr 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