Auth57 · Specialty PA Pack

Retina / Ophthalmology

For the retina specialist injecting anti-VEGF — the prior-auth and appeal map across all 51 states.

Unlock all 51 states →See a free state →

Structured rules

109

PA-required

50%

Appeal layer

51/51

Criteria docs

30/51

The breadth · all 51 jurisdictions

Every state, quantified for retina / ophthalmology

State	Rules	PA-required	Appeal	Criteria docs
AKAlaska	2	50%	✓	—
ALAlabama	2	50%	✓	1
ARArkansas	2	50%	✓	1
AZArizona	2	50%	✓	2
CACalifornia	2	50%	✓	6
COColorado	2	50%	✓	9
CTConnecticut	2	50%	✓	—
DCDistrict of Columbia	3	67%	✓	—
DEDelaware	2	50%	✓	—
FLFlorida	3	33%	✓	1
GAGeorgia	2	50%	✓	1
HIHawaii	2	50%	✓	—
IAIowa	2	50%	✓	1
IDIdaho	2	50%	✓	—
ILIllinois	2	50%	✓	3
INIndiana	2	50%	✓	2
KSKansas	2	50%	✓	2
KYKentucky	2	50%	✓	1
LALouisiana	2	50%	✓	4
MAMassachusetts	3	67%	✓	—
MDMaryland	2	50%	✓	—
MEMaine	2	50%	✓	1
MIMichigan	3	33%	✓	2
MNMinnesota	2	50%	✓	—
MOMissouri	2	50%	✓	—
MSMississippi	2	50%	✓	—
MTMontana	2	50%	✓	—
NCNorth Carolina	2	50%	✓	1
NDNorth Dakota	2	50%	✓	—
NENebraska	2	50%	✓	—
NHNew Hampshire	2	50%	✓	—
NJNew Jersey	3	33%	✓	1
NMNew Mexico	2	50%	✓	—
NVNevada	2	50%	✓	—
NYNew York	2	50%	✓	5
OHOhio	2	50%	✓	1
OKOklahoma	3	33%	✓	1
OROregon	2	50%	✓	1
PAPennsylvania	3	67%	✓	6
RIRhode Island	2	50%	✓	—
SCSouth Carolina	2	50%	✓	1
SDSouth Dakota	2	50%	✓	—
TNTennessee	2	50%	✓	2
TXTexas	2	50%	✓	2
UTUtah	2	50%	✓	1
VAVirginia	2	50%	✓	1
VTVermont	2	50%	✓	2
WAWashington	2	50%	✓	5
WIWisconsin	2	50%	✓	2
WVWest Virginia	2	50%	✓	—
WYWyoming	2	50%	✓	—

Free preview· Texas

What a fully-unlocked state looks like

commercial regulated

ophthalmic anti vegf(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. retinal disorders anti-VEGF, specialty/medical PA [e.g. aflibercept (EYLEA), ranibizumab (LUCENTIS), faricimab]

commercial qhp

ophthalmic anti vegf(Molina Healthcare)No PAMolina Healthcare commercial formulary. No oral/pharmacy anti-VEGF (Eylea/Lucentis) on this outpatient formulary

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 Retina / Ophthalmologypack — 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.