Archimedes Prior Authorization Form

Archimedes Prior Authorization Form - To preauthorize medications administered in your office or facility please use Archimedes Medication Preauthorization Request form Complete the form with applicable chart notes laboratory results and radiology findings and fax to 866 491 6971 or mail to Archimedes LLC 278 Franklin Rd Ste 245 Brentwood TN 37027

Member Support To reach a member services representative please contact us using the options below Phone 888 504 5563 Fax 866 491 6971 Email memberservices archimedesrx

Archimedes Prior Authorization Form

Archimedes Prior Authorization Form

For Fax or Mail use the forms below: Medical Drug Prior authorization and appeals form: Physician Fax Form (PDF) Prior authorization and appeal requests can be submitted by . PHONE: (888) 504-5563 . MAIL: Archimedes, LLC 278 Franklin Rd. Ste 245 Brentwood, TN 37027 . FAX: (866) 491-6971

MEDICATION PREAUTHORIZATION REQUEST PHYSICIAN FAX FORM Only the prescriber may complete this form This form is for prospective concurrent and retrospective reviews PLEASE INCLUDE APPLICABLE CHART NOTES LABORATORY RESULTS and RADIOLOGY FINDINGS Incomplete forms will be returned for additional

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Leverages Archimedes clinical expertise and technology to implement a robust prior authorization program and case management for high cost specialty patients Utilizes health economics to support formularies that prioritize value The New Standard for Specialty Drug Management Technology Request a Demo Opportunity Identification and

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How do providers contact Archimedes to request a prior authorization PA or re authorization Fax all PA requests to Archimedes at 866 491 6971 The general PA form can be obtained at archimedesrx resources or dmba provider For additional information call Archimedes at 888 504 5563 Monday through Friday 8 a m

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Drugs Requiring Prior Authorization by Archimedes Abraxane paclitaxel protein bound particles Actemra tocilizumab Acthar corticotropin ACTH Adagen pegademase bovine Adcetris brentuximab Akynzeo fosnetupitant palonosetron Aldurazyme laronidase Alimta pemetrexed Aliqopa copanlisib Aloxi palonosetron Alymsys

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Learn how Archimedes can help you address the rising cost of specialty medications across the medical and pharmacy benefits

Robust clinical management including rigorous prior authorization, promotion of first-line therapies and biosimilar first policy Interventions to optimize channel and sites of care for infusions. Medical claims editing and monitoring for billing errors.

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To request preauthorization call Archimedes Rx at 1 888 504 5563 Specialty drugs not included on the medical pharmacy drug list may require preauthorization through Navitus Health Solutions For questions please call Navitus at 1 833 354 2226

Archimedes Prior Authorization Form

Learn how Archimedes can help you address the rising cost of specialty medications across the medical and pharmacy benefits

Member Support To reach a member services representative please contact us using the options below Phone 888 504 5563 Fax 866 491 6971 Email memberservices archimedesrx

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