Auth57 · Specialty PA Pack
Allergy / Immunology
For the allergist running asthma biologics and immunoglobulin — PA rules and appeal paths, every state.
Structured rules
634
PA-required
100%
Appeal layer
51/51
Criteria docs
47/51
The breadth · all 51 jurisdictions
Every state, quantified for allergy / immunology
| State | Rules | PA-required | Appeal | Criteria docs |
|---|---|---|---|---|
| AKAlaska | 9 | 100% | ✓ | 4 |
| ALAlabama | 13 | 100% | ✓ | 5 |
| ARArkansas | 15 | 100% | ✓ | 3 |
| AZArizona | 14 | 100% | ✓ | 2 |
| CACalifornia | 14 | 100% | ✓ | 9 |
| COColorado | 14 | 100% | ✓ | 5 |
| CTConnecticut | 12 | 100% | ✓ | 2 |
| DCDistrict of Columbia | 12 | 100% | ✓ | 2 |
| DEDelaware | 14 | 100% | ✓ | 3 |
| FLFlorida | 13 | 100% | ✓ | 3 |
| GAGeorgia | 14 | 100% | ✓ | 7 |
| HIHawaii | 14 | 100% | ✓ | 4 |
| IAIowa | 13 | 92% | ✓ | 5 |
| IDIdaho | 11 | 100% | ✓ | 6 |
| ILIllinois | 13 | 100% | ✓ | 3 |
| INIndiana | 13 | 100% | ✓ | 5 |
| KSKansas | 12 | 100% | ✓ | 23 |
| KYKentucky | 13 | 100% | ✓ | 5 |
| LALouisiana | 11 | 100% | ✓ | 15 |
| MAMassachusetts | 12 | 100% | ✓ | 2 |
| MDMaryland | 11 | 100% | ✓ | 5 |
| MEMaine | 13 | 100% | ✓ | 2 |
| MIMichigan | 12 | 100% | ✓ | 11 |
| MNMinnesota | 10 | 100% | ✓ | 1 |
| MOMissouri | 14 | 100% | ✓ | 3 |
| MSMississippi | 15 | 100% | ✓ | 28 |
| MTMontana | 10 | 100% | ✓ | 2 |
| NCNorth Carolina | 14 | 100% | ✓ | 12 |
| NDNorth Dakota | 10 | 100% | ✓ | 1 |
| NENebraska | 12 | 100% | ✓ | 4 |
| NHNew Hampshire | 12 | 100% | ✓ | — |
| NJNew Jersey | 12 | 100% | ✓ | 2 |
| NMNew Mexico | 10 | 100% | ✓ | — |
| NVNevada | 12 | 100% | ✓ | 12 |
| NYNew York | 13 | 100% | ✓ | 10 |
| OHOhio | 14 | 100% | ✓ | 7 |
| OKOklahoma | 14 | 100% | ✓ | 3 |
| OROregon | 13 | 100% | ✓ | 3 |
| PAPennsylvania | 12 | 100% | ✓ | 15 |
| RIRhode Island | 10 | 100% | ✓ | — |
| SCSouth Carolina | 13 | 100% | ✓ | 2 |
| SDSouth Dakota | 9 | 100% | ✓ | 2 |
| TNTennessee | 13 | 100% | ✓ | 1 |
| TXTexas | 15 | 100% | ✓ | 25 |
| UTUtah | 14 | 100% | ✓ | 6 |
| VAVirginia | 14 | 100% | ✓ | 5 |
| VTVermont | 9 | 100% | ✓ | 2 |
| WAWashington | 14 | 100% | ✓ | 2 |
| WIWisconsin | 13 | 100% | ✓ | 4 |
| WVWest Virginia | 11 | 100% | ✓ | — |
| WYWyoming | 10 | 100% | ✓ | 4 |
Free preview· Texas
What a fully-unlocked state looks like
medicaid ffs
- asthma copd biologicsPA requiredTX Medicaid PDL: non-preferred agents require PA (step therapy). Source: Acentra TX PDL Criteria Guide 2026-01-30 (official companion to TX Medicaid PDL).
- immunoglobulinsPA requiredTX Medicaid PDL: non-preferred agents require PA (step therapy). Source: Acentra TX PDL Criteria Guide 2026-01-30 (official companion to TX Medicaid PDL).
commercial regulated
- asthma copd biologics(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Asthma/COPD biologic subset within asthma/COPD heading; all carry PA+QL+SP [e.g. FASENRA, NUCALA, TEZSPIRE, XOLAIR]
- asthma copd biologics(Cigna)PA requiredCigna commercial (Advantage 3-Tier). respiratory biologics carry SP+PA [e.g. FASENRA PEN, NUCALA, TEZSPIRE, XOLAIR]
- immunoglobulins(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. immunoglobulin, specialty PA [e.g. IVIG / SCIG (GAMMAGARD, HIZENTRA, PRIVIGEN)]
- asthma copd biologics(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. severe asthma biologics, specialty PA [e.g. omalizumab (XOLAIR), mepolizumab (NUCALA), benralizumab (FASENRA), dupilumab]
- immunoglobulins(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. Passive immunizing agents (IG combinations): PA + SP [e.g. HYQVIA immune globulin]
part d
- asthma copd biologics(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- asthma copd biologics(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- asthma copd biologics(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- asthma copd biologics(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- asthma copd biologics(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
commercial qhp
- asthma copd biologics(Marketplace QHP (aggregate))PA requiredACA marketplace QHP — aggregated across the state's exchange issuers (PA if any issuer gates the class). Source: CMS machine-readable formulary PUF.
- immunoglobulins(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. Immune serums (IVIG/SCIG) carry 12 PA
- asthma copd biologics(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. Anti-IgE and IL-5 antagonist respiratory biologics carry PA
If denied in Texas
📨 Program Support Unit (PSU)
Unlock the full pack
Full criteria, sources & appeal paths — all 51 states.
You’ve seen the breadth and one state in full. The complete Allergy / Immunologypack — every state’s criteria, source citations, and step-by-step appeal instructions — is one email away.
Assembled from Auth57’s rules + criteria corpus + 51-state appeal layer. Draft data — verify against the payer’s current policy before relying.