Auth57 · Specialty PA Pack
Endocrinology
For the endocrinologist on GLP-1s, insulin, and growth hormone — where PA bites, and exactly how to clear it.
Structured rules
1,583
PA-required
81%
Appeal layer
51/51
Criteria docs
50/51
The breadth · all 51 jurisdictions
Every state, quantified for endocrinology
| State | Rules | PA-required | Appeal | Criteria docs |
|---|---|---|---|---|
| AKAlaska | 21 | 86% | ✓ | 4 |
| ALAlabama | 33 | 82% | ✓ | 6 |
| ARArkansas | 36 | 81% | ✓ | 8 |
| AZArizona | 33 | 82% | ✓ | 5 |
| CACalifornia | 36 | 78% | ✓ | 11 |
| COColorado | 33 | 79% | ✓ | 6 |
| CTConnecticut | 33 | 79% | ✓ | 11 |
| DCDistrict of Columbia | 33 | 79% | ✓ | 8 |
| DEDelaware | 33 | 82% | ✓ | 4 |
| FLFlorida | 33 | 82% | ✓ | 4 |
| GAGeorgia | 36 | 78% | ✓ | 20 |
| HIHawaii | 33 | 76% | ✓ | 9 |
| IAIowa | 33 | 82% | ✓ | 13 |
| IDIdaho | 24 | 79% | ✓ | 10 |
| ILIllinois | 32 | 81% | ✓ | 2 |
| INIndiana | 33 | 82% | ✓ | 8 |
| KSKansas | 33 | 82% | ✓ | 11 |
| KYKentucky | 36 | 78% | ✓ | 4 |
| LALouisiana | 30 | 83% | ✓ | 17 |
| MAMassachusetts | 27 | 81% | ✓ | 14 |
| MDMaryland | 30 | 80% | ✓ | 22 |
| MEMaine | 30 | 80% | ✓ | 4 |
| MIMichigan | 30 | 83% | ✓ | 13 |
| MNMinnesota | 24 | 83% | ✓ | 2 |
| MOMissouri | 38 | 79% | ✓ | 5 |
| MSMississippi | 36 | 81% | ✓ | 9 |
| MTMontana | 24 | 83% | ✓ | 4 |
| NCNorth Carolina | 36 | 81% | ✓ | 31 |
| NDNorth Dakota | 24 | 83% | ✓ | 8 |
| NENebraska | 30 | 83% | ✓ | 4 |
| NHNew Hampshire | 30 | 83% | ✓ | — |
| NJNew Jersey | 30 | 80% | ✓ | 3 |
| NMNew Mexico | 24 | 75% | ✓ | 5 |
| NVNevada | 29 | 79% | ✓ | 22 |
| NYNew York | 33 | 79% | ✓ | 9 |
| OHOhio | 36 | 81% | ✓ | 15 |
| OKOklahoma | 36 | 81% | ✓ | 3 |
| OROregon | 36 | 81% | ✓ | 3 |
| PAPennsylvania | 30 | 80% | ✓ | 23 |
| RIRhode Island | 24 | 83% | ✓ | 3 |
| SCSouth Carolina | 32 | 81% | ✓ | 6 |
| SDSouth Dakota | 21 | 81% | ✓ | 3 |
| TNTennessee | 33 | 82% | ✓ | 6 |
| TXTexas | 36 | 81% | ✓ | 54 |
| UTUtah | 33 | 82% | ✓ | 16 |
| VAVirginia | 36 | 78% | ✓ | 20 |
| VTVermont | 21 | 81% | ✓ | 8 |
| WAWashington | 36 | 78% | ✓ | 11 |
| WIWisconsin | 33 | 82% | ✓ | 2 |
| WVWest Virginia | 27 | 85% | ✓ | 2 |
| WYWyoming | 24 | 83% | ✓ | 9 |
Free preview· Texas
What a fully-unlocked state looks like
medicaid ffs
- glp1 agonistsPA 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).
- insulinsPA 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).
- growth hormonePA 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
- glp1 agonists(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). GLP-1 (and GLP-1/GIP) agonists within Diabetes-Non-insulin; all carry PA+QL [e.g. OZEMPIC, MOUNJARO, TRULICITY, RYBELSUS]
- insulins(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Diabetes-Insulin; almost all QL only, but NOVOLIN R FLEXPEN carries ST; no true PA [e.g. HUMALOG, HUMULIN, LANTUS, insulin lispro]
- growth hormone(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Hormonal-Other; growth hormones (NGENLA, NORDITROPIN, OMNITROPE, SKYTROFA) and GnRH agents (ORIAHNN, ORILISSA) all carry PA+QL(+SP) [e.g. NGENLA, NORDITROPIN FLEXPRO, OMNITROPE, SKYTROFA]
- insulins(Cigna)No PACigna commercial (Advantage 3-Tier). insulins open, QL only [e.g. LANTUS, HUMALOG, TRESIBA, INSULIN LISPRO]
- growth hormone(Cigna)PA requiredCigna commercial (Advantage 3-Tier). somatropins SP+PA in hormonal agents section [e.g. GENOTROPIN, OMNITROPE, NGENLA, NorditropI]
- glp1 agonists(Cigna)PA requiredCigna commercial (Advantage 3-Tier). GLP-1 agonists carry PA+QL [e.g. OZEMPIC, MOUNJARO, TRULICITY, RYBELSUS]
- insulins(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. insulins, preferred brands; ST/formulary-preferred [e.g. insulin glargine, insulin lispro, insulin aspart, HUMALOG]
- growth hormone(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. human growth hormones, specialty PA [e.g. somatropin (NORDITROPIN, GENOTROPIN, HUMATROPE)]
- glp1 agonists(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. incretin mimetic agents + combos, PA/ST (diabetes indication edits) [e.g. OZEMPIC, MOUNJARO, TRULICITY, RYBELSUS]
- glp1 agonists(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. Incretin mimetic GLP-1 receptor agonists: PA + QL [e.g. liraglutide, dulaglutide, exenatide]
- insulins(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. Human insulin subclass carries PA + QL in this listing [e.g. HUMALOG, insulin lispro, insulin (human)]
- growth hormone(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. Growth hormones: PA + SP (some ST) [e.g. OMNITROPE somatropin, growth hormones]
part d
- growth hormone(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- insulins(Centene)No PACentene Part D (CMS formulary file, plan-grounded).
- glp1 agonists(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- growth hormone(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- glp1 agonists(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- insulins(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- growth hormone(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- insulins(Humana)No PAHumana Part D (CMS formulary file, plan-grounded).
- glp1 agonists(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- growth hormone(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- insulins(Cigna)No PACigna Part D (CMS formulary file, plan-grounded).
- glp1 agonists(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- insulins(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- glp1 agonists(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- growth hormone(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
commercial qhp
- glp1 agonists(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.
- insulins(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.
- growth hormone(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.
- glp1 agonists(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. Ozempic/Trulicity/Rybelsus/liraglutide all carry ST
- insulins(Molina Healthcare)No PAMolina Healthcare commercial formulary. Human Insulin section only QL/MAIL/$35 cap, no PA/ST
- growth hormone(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. Growth Hormones section 4 PA flags
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 Endocrinologypack — 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.