Ofev 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 08, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 08, 2026

Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 08, 2026

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

CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 08, 2026

Cigna - General Medication Prior Authorization FormCigna Corporation · Updated May 08, 2026

Cigna - Ofev Prior Authorization Form Cigna Corporation · Updated May 16, 2026

ICD-10 codes for Ofev Prior Authorizations

J84.11Idiopathic interstitial pneumonia

J84.10Pulmonary fibrosis, unspecified

J84.17Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere

J84.1Other interstitial pulmonary diseases with fibrosis

M34.81Systemic sclerosis with lung involvement

M34Systemic sclerosis [scleroderma]

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.

Coverage Authorization Appeals - Physican: IPFCoverage Authorization Appeals - Physican: IPF resource

Coverage Authorization Appeals - Patient: IPFCoverage Authorization Appeals - Patient: IPF resource

Letter of Medical Necessity - Physician: IPFLetter of Medical Necessity - Physician: IPF resource

Letter of Medical Necessity - Patient: IPF Letter of Medical Necessity - Patient: IPF resource

Appeals Tips & Checklist: IPFAppeals Tips & Checklist: IPF resource

Appeals Tips & Checklist - Spanish: IPFAppeals Tips & Checklist - Spanish: IPF resource

Coverage Authorization Appeal - Physician: SSc-ILDCoverage Authorization Appeal - Physician: SSc-ILD resource

Coverage Authorization Appeals - Patient: SSc-ILDCoverage Authorization Appeals - Patient: SSc-ILD resource

Letter of Medical Necessity: SSc-ILDLetter of Medical Necessity: SSc-ILD resource

Coverage Authorization Appeals - Physician: Chronic Fibrosing ILDs with a Progressive PhenotypeCoverage Authorization Appeals - Physician: Chronic Fibrosing ILDs with a Progressive Phenotype resource

Coverage Authorization Appeals - Patient: Chronic Fibrosing ILDs with a Progressive PhenotypeCoverage Authorization Appeals - Patient: Chronic Fibrosing ILDs with a Progressive Phenotype resource

Letter of Medical Necessity: Chronic Fibrosing ILDs with a Progressive PhenotypeLetter of Medical Necessity: Chronic Fibrosing ILDs with a Progressive Phenotype 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

Reimbursement InformationReimbursement Information resource

PA Tips & Checklist: IPFPA Tips & Checklist: IPF resource

PA Tips & Checklist - Spanish: IPFPA Tips & Checklist - Spanish: IPF resource

Letter of Medical Exception: SSc-ILDLetter of Medical Exception: SSc-ILD resource

Letter of Medical Exception: Chronic Fibrosing ILDs with a Progressive PhenotypeLetter of Medical Exception: Chronic Fibrosing ILDs with a Progressive Phenotype resource

Support for Getting Your Patient on Ofev

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.