Cimzia® (certolizumab)

Authorization forms

(authorization is required for both pharmacy and medical coverage)

Traditional & Optimized (09/2019)

Medicaid (07/2019)

Medicare Part B and Part D (01/2019)

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page