Drugs Requiring Precertification

How to Submit for Precertification

The drugs listed are reviewed by Archimedes. Providers should complete the Archimedes precertification form and fax it and any chart notes to Archimedes at 866-229-0028.

If you have questions, please contact Archimedes at 888-341-0802 or email ClinicalPrograms@Archimedesrx.com.

View Drug List

View the list of drugs that Archimedes will be reviewing. This list will be updated quarterly.

 

View list

Thumbnail of drug list

Download Precertification Form

View and download the precertification form. This form must be completed and submitted by a provider.

 

Download form

Thumbnail of pre-cert form