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Neurology care
Auth57 · Specialty PA Pack

Neurology

For the neurologist managing MS and migraine therapies — coverage, criteria, and appeals across all 51 states.

Unlock all 51 states →See a free state →
Structured rules
1,002
PA-required
99%
Appeal layer
51/51
Criteria docs
44/51
The breadth · all 51 jurisdictions

Every state, quantified for neurology

StateRulesPA-requiredAppealCriteria docs
AKAlaska13100%✓2
ALAlabama21100%✓6
ARArkansas23100%✓2
AZArizona21100%✓6
CACalifornia2396%✓7
COColorado2195%✓10
CTConnecticut21100%✓3
DCDistrict of Columbia2195%✓9
DEDelaware20100%✓3
FLFlorida21100%✓—
GAGeorgia2396%✓12
HIHawaii2195%✓5
IAIowa21100%✓6
IDIdaho15100%✓1
ILIllinois20100%✓—
INIndiana21100%✓2
KSKansas20100%✓11
KYKentucky23100%✓3
LALouisiana19100%✓9
MAMassachusetts17100%✓1
MDMaryland1995%✓9
MEMaine19100%✓3
MIMichigan19100%✓6
MNMinnesota15100%✓2
MOMissouri25100%✓1
MSMississippi23100%✓8
MTMontana15100%✓2
NCNorth Carolina23100%✓6
NDNorth Dakota15100%✓—
NENebraska19100%✓3
NHNew Hampshire19100%✓—
NJNew Jersey19100%✓3
NMNew Mexico15100%✓3
NVNevada19100%✓16
NYNew York21100%✓3
OHOhio23100%✓14
OKOklahoma23100%✓—
OROregon2295%✓3
PAPennsylvania19100%✓8
RIRhode Island15100%✓—
SCSouth Carolina21100%✓7
SDSouth Dakota13100%✓—
TNTennessee21100%✓4
TXTexas23100%✓39
UTUtah21100%✓11
VAVirginia2396%✓5
VTVermont13100%✓6
WAWashington23100%✓6
WIWisconsin21100%✓3
WVWest Virginia16100%✓1
WYWyoming15100%✓5
Free preview· Texas

What a fully-unlocked state looks like

medicaid ffs
  • ms disease modifyingPA requiredCorrected to PA-required via cross-state consensus + source re-verification: clinical judgment, low confidence (no source); 95% cross-state norm
  • migraine cgrpPA 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
  • ms disease modifying(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). CNS-multiple sclerosis; all agents carry PA+QL+SP (MAVENCLAD adds ST) [e.g. AVONEX, KESIMPTA, MAVENCLAD, MAYZENT]
  • migraine cgrp(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Antimigraine-migraines; CGRP agents (AIMOVIG, NURTEC, QULIPTA, UBRELVY, ZAVZPRET) carry PA+ST+QL; triptans QL only [e.g. AIMOVIG, EMGALITY, NURTEC, QULIPTA]
  • ms disease modifying(Cigna)PA requiredCigna commercial (Advantage 3-Tier). MS DMTs SP, injectables/orals PA (generics SP only) [e.g. AVONEX, KESIMPTA, MAYZENT, VUMERITY]
  • migraine cgrp(Cigna)PA requiredCigna commercial (Advantage 3-Tier). CGRP mAbs and gepants carry PA [e.g. AIMOVIG, AJOVY, EMGALITY, NURTEC ODT]
  • migraine cgrp(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. CGRP monoclonal antibodies, specialty PA/ST [e.g. AIMOVIG, EMGALITY, AJOVY (CGRP mAbs)]
  • migraine cgrp(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. CGRP receptor antagonist monoclonal antibodies: PA + QL [e.g. EMGALITY galcanezumab, CGRP monoclonal antibodies]
  • ms disease modifying(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. MS agents (interferons, NRF2, pyrimidine synthesis, K-channel blockers, oral): PA + SP; monoclonal abs vary [e.g. teriflunomide, dimethyl fumarate, interferon beta, TYSABRI natalizumab]
part d
  • migraine cgrp(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
  • ms disease modifying(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
  • migraine cgrp(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
  • ms disease modifying(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
  • migraine cgrp(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
  • ms disease modifying(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
  • migraine cgrp(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
  • ms disease modifying(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
  • migraine cgrp(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
  • ms disease modifying(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
commercial qhp
  • migraine cgrp(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.
  • ms disease modifying(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.
  • migraine cgrp(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. Ubrelvy/Ajovy/Emgality (gepants + CGRP mAbs) carry PA
  • ms disease modifying(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. MS agents, interferons, and pyrimidine-synthesis inhibitor all PA
If denied in Texas
📨 Program Support Unit (PSU)
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Full criteria, sources & appeal paths — all 51 states.

You’ve seen the breadth and one state in full. The complete Neurologypack — every state’s criteria, source citations, and step-by-step appeal instructions — is one email away.

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Assembled from Auth57’s rules + criteria corpus + 51-state appeal layer. Draft data — verify against the payer’s current policy before relying.