Auth57 · Specialty PA Pack
Cardiology
For the cardiologist on DOACs, PCSK9s, and PAH therapy — what needs PA (often less than you'd think), and how to appeal.
Structured rules
3,924
PA-required
43%
Appeal layer
51/51
Criteria docs
49/51
The breadth · all 51 jurisdictions
Every state, quantified for cardiology
| State | Rules | PA-required | Appeal | Criteria docs |
|---|---|---|---|---|
| AKAlaska | 49 | 47% | ✓ | 2 |
| ALAlabama | 80 | 43% | ✓ | 10 |
| ARArkansas | 92 | 45% | ✓ | 7 |
| AZArizona | 85 | 49% | ✓ | 7 |
| CACalifornia | 91 | 38% | ✓ | 8 |
| COColorado | 81 | 38% | ✓ | 13 |
| CTConnecticut | 81 | 42% | ✓ | 6 |
| DCDistrict of Columbia | 81 | 38% | ✓ | 11 |
| DEDelaware | 78 | 44% | ✓ | 4 |
| FLFlorida | 82 | 44% | ✓ | 3 |
| GAGeorgia | 93 | 37% | ✓ | 20 |
| HIHawaii | 85 | 39% | ✓ | 6 |
| IAIowa | 84 | 44% | ✓ | 11 |
| IDIdaho | 58 | 43% | ✓ | 4 |
| ILIllinois | 80 | 41% | ✓ | 1 |
| INIndiana | 80 | 46% | ✓ | 5 |
| KSKansas | 80 | 41% | ✓ | 10 |
| KYKentucky | 90 | 42% | ✓ | 4 |
| LALouisiana | 73 | 45% | ✓ | 8 |
| MAMassachusetts | 69 | 43% | ✓ | 3 |
| MDMaryland | 72 | 38% | ✓ | 12 |
| MEMaine | 72 | 40% | ✓ | 3 |
| MIMichigan | 74 | 49% | ✓ | 8 |
| MNMinnesota | 60 | 45% | ✓ | 1 |
| MOMissouri | 96 | 46% | ✓ | 4 |
| MSMississippi | 89 | 42% | ✓ | 17 |
| MTMontana | 57 | 46% | ✓ | 1 |
| NCNorth Carolina | 92 | 47% | ✓ | 20 |
| NDNorth Dakota | 56 | 38% | ✓ | 1 |
| NENebraska | 76 | 45% | ✓ | 6 |
| NHNew Hampshire | 74 | 46% | ✓ | — |
| NJNew Jersey | 77 | 38% | ✓ | 5 |
| NMNew Mexico | 61 | 38% | ✓ | 7 |
| NVNevada | 73 | 41% | ✓ | 18 |
| NYNew York | 85 | 45% | ✓ | 7 |
| OHOhio | 90 | 48% | ✓ | 14 |
| OKOklahoma | 93 | 48% | ✓ | 4 |
| OROregon | 88 | 43% | ✓ | 5 |
| PAPennsylvania | 74 | 42% | ✓ | 14 |
| RIRhode Island | 58 | 40% | ✓ | 3 |
| SCSouth Carolina | 80 | 43% | ✓ | 8 |
| SDSouth Dakota | 53 | 34% | ✓ | 3 |
| TNTennessee | 81 | 42% | ✓ | 6 |
| TXTexas | 90 | 47% | ✓ | 62 |
| UTUtah | 85 | 49% | ✓ | 18 |
| VAVirginia | 88 | 39% | ✓ | 9 |
| VTVermont | 49 | 43% | ✓ | 10 |
| WAWashington | 89 | 40% | ✓ | 11 |
| WIWisconsin | 80 | 48% | ✓ | 3 |
| WVWest Virginia | 65 | 49% | ✓ | — |
| WYWyoming | 55 | 42% | ✓ | 6 |
Free preview· Texas
What a fully-unlocked state looks like
medicaid ffs
- anticoagulants doacPA 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).
- antiplateletsPA 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).
- statinsPA 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).
- pcsk9 inhibitorsPA 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).
- pulmonary arterial hypertensionPA 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
- statins(UnitedHealthcare)No PAUnitedHealthcare commercial (Advantage 3-Tier). Statin subset within Cardiovascular heading; generics tier 1, H-PA/H preventive flags only, no standard PA/ST [e.g. atorvastatin, rosuvastatin, simvastatin, pravastatin]
- anticoagulants doac(UnitedHealthcare)No PAUnitedHealthcare commercial (Advantage 3-Tier). Anticoagulants-blood clots; QL only on DOACs, no PA/ST [e.g. ELIQUIS, XARELTO, dabigatran, rivaroxaban]
- pulmonary arterial hypertension(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Respiratory-pulmonary hypertension; all carry PA+QL+SP (TYVASO PA+SP) [e.g. ADEMPAS, OPSUMIT, TYVASO, TADLIQ]
- pcsk9 inhibitors(UnitedHealthcare)No PAUnitedHealthcare commercial (Advantage 3-Tier). PCSK9 subset within Cardiovascular heading; REPATHA carries QL only here, no PA [e.g. REPATHA]
- antiplatelets(UnitedHealthcare)No PAUnitedHealthcare commercial (Advantage 3-Tier). Antiplatelets-heart attack/stroke; QL only on ticagrelor, no PA/ST [e.g. clopidogrel, ticagrelor, prasugrel, cilostazol]
- pcsk9 inhibitors(Cigna)No PACigna commercial (Advantage 3-Tier). REPATHA listed without PA/ST in this plan [e.g. REPATHA]
- statins(Cigna)No PACigna commercial (Advantage 3-Tier). statins open (PPACA/QL); LIPOFEN/TRICOR fibrate=ST [e.g. atorvastatin, rosuvastatin, simvastatin, pravastatin]
- arbs(Cigna)PA requiredCigna commercial (Advantage 3-Tier). oral ARBs mostly open but ARBLI=PA, valsartan oral soln/DIOVAN=ST [e.g. losartan, valsartan, irbesartan, ARBLI]
- beta blockers(Cigna)No PACigna commercial (Advantage 3-Tier). beta blockers open (QL only) [e.g. metoprolol er, carvedilol, atenolol, nebivolol]
- anticoagulants doac(Cigna)No PACigna commercial (Advantage 3-Tier). DOACs/warfarin open in blood thinners section [e.g. ELIQUIS, XARELTO, dabigatran, warfarin]
- ace inhibitors(Cigna)No PACigna commercial (Advantage 3-Tier). ACE inhibitors open [e.g. lisinopril, enalapril, lisinopril-hctz]
- pulmonary arterial hypertension(Cigna)PA requiredCigna commercial (Advantage 3-Tier). PAH agents in respiratory section, SP+PA [e.g. ADEMPAS, OPSUMIT, TRACLEER, TYVASO]
- antiplatelets(Cigna)No PACigna commercial (Advantage 3-Tier). antiplatelets open [e.g. clopidogrel, prasugrel, ZONTIVITY]
- arbs(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. ARBs + combos, open generics [e.g. losartan, valsartan, olmesartan, irbesartan]
- pulmonary arterial hypertension(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. specialty PAH, PA standard [e.g. sildenafil (PAH), tadalafil (PAH), ambrisentan, bosentan]
- anticoagulants doac(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. anticoagulants/blood thinners, brand DOACs preferred; some ST [e.g. apixaban (ELIQUIS), rivaroxaban (XARELTO), warfarin, dabigatran]
- statins(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. HMG-CoA reductase inhibitors, open generics [e.g. atorvastatin, rosuvastatin, simvastatin, pravastatin]
- antiplatelets(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. platelet aggregation inhibitors, open generics; BRILINTA brand [e.g. clopidogrel, prasugrel, ticagrelor (BRILINTA), aspirin-dipyridamole]
- ace inhibitors(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. open generics incl ACE combos [e.g. lisinopril, enalapril, benazepril, ramipril]
- pcsk9 inhibitors(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. specialty PSP; PA + step after statins standard [e.g. REPATHA (evolocumab), PRALUENT (alirocumab)]
- beta blockers(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. beta-blockers + diuretic combos, open generics [e.g. metoprolol, carvedilol, atenolol, propranolol]
- statins(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. HMG-CoA reductase inhibitors: no PA, open [e.g. atorvastatin, rosuvastatin, simvastatin, pravastatin]
- beta blockers(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. Alpha-beta/cardioselective/nonselective: QL only, open [e.g. metoprolol, carvedilol, atenolol, propranolol]
- anticoagulants doac(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. Direct factor Xa inhibitors: PA on some agents (Eliquis QL-only but class carries PA+ST) [e.g. rivaroxaban, SAVAYSA edoxaban, apixaban (ELIQUIS)]
- pcsk9 inhibitors(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. PCSK9 inhibitors carry PA + QL [e.g. alirocumab, evolocumab (REPATHA/PRALUENT)]
- pulmonary arterial hypertension(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. Prostaglandin vasodilators, endothelin receptor antagonists, PDE5, sGC stimulators: PA + SP [e.g. treprostinil, ambrisentan, tadalafil (ALYQ), ADEMPAS riociguat]
- ace inhibitors(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. ACE inhibitors + combos: open [e.g. lisinopril, enalapril, benazepril, ramipril]
- antiplatelets(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. P2Y12/thienopyridine/platelet inhibitors: QL only, open [e.g. clopidogrel, ticagrelor, prasugrel, dipyridamole]
- arbs(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. Angiotensin II receptor antagonists + combos: QL only, open [e.g. losartan, valsartan, irbesartan, olmesartan]
part d
- arbs(Humana)No PAHumana Part D (CMS formulary file, plan-grounded).
- ace inhibitors(Centene)No PACentene Part D (CMS formulary file, plan-grounded).
- arbs(Centene)No PACentene Part D (CMS formulary file, plan-grounded).
- beta blockers(Centene)No PACentene Part D (CMS formulary file, plan-grounded).
- pulmonary arterial hypertension(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- antiplatelets(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- pcsk9 inhibitors(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- statins(Centene)No PACentene Part D (CMS formulary file, plan-grounded).
- anticoagulants doac(Centene)No PACentene Part D (CMS formulary file, plan-grounded).
- antiplatelets(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- arbs(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- anticoagulants doac(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- ace inhibitors(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- pulmonary arterial hypertension(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- beta blockers(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- statins(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- pcsk9 inhibitors(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- ace inhibitors(Humana)No PAHumana Part D (CMS formulary file, plan-grounded).
- anticoagulants doac(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- pulmonary arterial hypertension(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- statins(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- beta blockers(Humana)No PAHumana Part D (CMS formulary file, plan-grounded).
- antiplatelets(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- pcsk9 inhibitors(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- anticoagulants doac(Cigna)No PACigna Part D (CMS formulary file, plan-grounded).
- arbs(Cigna)No PACigna Part D (CMS formulary file, plan-grounded).
- ace inhibitors(Cigna)No PACigna Part D (CMS formulary file, plan-grounded).
- antiplatelets(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- beta blockers(Cigna)No PACigna Part D (CMS formulary file, plan-grounded).
- pulmonary arterial hypertension(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- statins(Cigna)No PACigna Part D (CMS formulary file, plan-grounded).
- pcsk9 inhibitors(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- statins(Aetna)No PAAetna Part D (CMS formulary file, plan-grounded).
- pcsk9 inhibitors(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- ace inhibitors(Aetna)No PAAetna Part D (CMS formulary file, plan-grounded).
- antiplatelets(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- beta blockers(Aetna)No PAAetna Part D (CMS formulary file, plan-grounded).
- anticoagulants doac(Aetna)No PAAetna Part D (CMS formulary file, plan-grounded).
- arbs(Aetna)No PAAetna Part D (CMS formulary file, plan-grounded).
- pulmonary arterial hypertension(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
commercial qhp
- beta blockers(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.
- pulmonary arterial hypertension(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.
- anticoagulants doac(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.
- ace inhibitors(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.
- pcsk9 inhibitors(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.
- arbs(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.
- statins(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.
- antiplatelets(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.
- anticoagulants doac(Molina Healthcare)No PAMolina Healthcare commercial formulary. Eliquis/Xarelto (Direct Factor Xa) QL only, no PA/ST
- statins(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. fluvastatin ER ST plus a PA; most statins open
- antiplatelets(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. P2Y12, platelet-aggregation and PAR-1 inhibitors carry PA; thienopyridines open
- pcsk9 inhibitors(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. 3 PA flags in PCSK9 inhibitor section
- ace inhibitors(Molina Healthcare)No PAMolina Healthcare commercial formulary. ACE Inhibitors section open, no PA/ST
- beta blockers(Molina Healthcare)No PAMolina Healthcare commercial formulary. Cardioselective/non-selective/alpha-beta blockers all open
- pulmonary arterial hypertension(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. Prostaglandin vasodilators / PAH agents carry 14 PA
- arbs(Molina Healthcare)No PAMolina Healthcare commercial formulary. Angiotensin II Receptor Antagonists section open
If denied in Texas
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Unlock the full pack
Full criteria, sources & appeal paths — all 51 states.
You’ve seen the breadth and one state in full. The complete Cardiologypack — 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.