Simponi® and Simponi Aria® (golimumab)

Authorization forms

Simponi (covered under the pharmacy benefit)

Traditional & Optimized (01/2019)

Medicare Part D (01/2019)

Simponi Aria (covered under the medical benefit):

Traditional & Optimized (01/2019)

Medicaid (07/2019)

Medicare Part B (10/2019)

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page