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Cardiology care
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.

Unlock all 51 states →See a free state →
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

StateApproved · CY25RulesPA-requiredAppealCriteria docs
● Recent · CY2025 disclosures — click a state to drill in
WAWashington▸ viewing88.2%8940%✓11
COColorado91.8%8138%✓13
OHOhio77.7%9048%✓14
All states · A–Z
AKAlaska—4947%✓2
ALAlabama—8043%✓10
ARArkansas—9245%✓7
AZArizona—8549%✓7
CACalifornia—9138%✓8
CTConnecticut—8142%✓6
DCDistrict of Columbia—8138%✓11
DEDelaware—7844%✓4
FLFlorida—8244%✓3
GAGeorgia—9337%✓20
HIHawaii—8539%✓6
IAIowa—8444%✓11
IDIdaho—5843%✓4
ILIllinois—8041%✓1
INIndiana—8046%✓5
KSKansas—8041%✓10
KYKentucky—9042%✓4
LALouisiana—7345%✓8
MAMassachusetts—6943%✓3
MDMaryland—7238%✓12
MEMaine—7240%✓3
MIMichigan—7449%✓8
MNMinnesota—6045%✓1
MOMissouri—9646%✓4
MSMississippi—8942%✓17
MTMontana—5746%✓1
NCNorth Carolina—9247%✓20
NDNorth Dakota—5638%✓1
NENebraska—7645%✓6
NHNew Hampshire—7446%✓—
NJNew Jersey—7738%✓5
NMNew Mexico—6138%✓7
NVNevada—7341%✓18
NYNew York—8545%✓7
OKOklahoma—9348%✓4
OROregon—8843%✓5
PAPennsylvania—7442%✓14
RIRhode Island—5840%✓3
SCSouth Carolina—8043%✓8
SDSouth Dakota—5334%✓3
TNTennessee—8142%✓6
TXTexas—9047%✓62
UTUtah—8549%✓18
VAVirginia—8839%✓9
VTVermont—4943%✓10
WIWisconsin—8048%✓3
WVWest Virginia—6549%✓—
WYWyoming—5542%✓6
Deep dive· Washington

Washington — cardiology, every program

Click any state in the table above to drill into its rules, approval rates, and appeal path.

● Rules verified as-of Jun 8, 2026
Medicaid FFS · CY25
54.8%approved
Draft · aggregatedSource ↗⚠ Dental = ~78% of HCA fee-for-service PA volume and is dental-skewed; expedited EPAs aren't captured. Not representative of drug/medical PA. CY2025 data is preliminary.
Medicaid MCO · CY25
88.2%approved · 4 payers
Draft · aggregatedSource ↗
medicaid ffs
Approved · CMS-0057-F 202554.8%
Draft · aggregatedSource ↗⚠ Dental = ~78% of HCA fee-for-service PA volume and is dental-skewed; expedited EPAs aren't captured. Not representative of drug/medical PA. CY2025 data is preliminary.
  • pulmonary arterial hypertensionPA required

    WA Medicaid PDL: non-preferred agents in this class require PA.

  • anticoagulants doacPA required

    WA Medicaid PDL: non-preferred agents in this class require PA.

  • statinsPA required

    WA Medicaid PDL: non-preferred agents in this class require PA.

  • pcsk9 inhibitorsPA required

    WA Medicaid PDL: non-preferred agents in this class require PA.

commercial regulated
  • statins(UnitedHealthcare)No PA

    UnitedHealthcare 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 PA

    UnitedHealthcare commercial (Advantage 3-Tier). Anticoagulants-blood clots; QL only on DOACs, no PA/ST [e.g. ELIQUIS, XARELTO, dabigatran, rivaroxaban]

  • antiplatelets(UnitedHealthcare)No PA

    UnitedHealthcare commercial (Advantage 3-Tier). Antiplatelets-heart attack/stroke; QL only on ticagrelor, no PA/ST [e.g. clopidogrel, ticagrelor, prasugrel, cilostazol]

  • pcsk9 inhibitors(UnitedHealthcare)No PA

    UnitedHealthcare commercial (Advantage 3-Tier). PCSK9 subset within Cardiovascular heading; REPATHA carries QL only here, no PA [e.g. REPATHA]

  • pulmonary arterial hypertension(UnitedHealthcare)PA required

    UnitedHealthcare commercial (Advantage 3-Tier). Respiratory-pulmonary hypertension; all carry PA+QL+SP (TYVASO PA+SP) [e.g. ADEMPAS, OPSUMIT, TYVASO, TADLIQ]

  • ace inhibitors(Cigna)No PA

    Cigna commercial (Advantage 3-Tier). ACE inhibitors open [e.g. lisinopril, enalapril, lisinopril-hctz]

  • arbs(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). oral ARBs mostly open but ARBLI=PA, valsartan oral soln/DIOVAN=ST [e.g. losartan, valsartan, irbesartan, ARBLI]

  • anticoagulants doac(Cigna)No PA

    Cigna commercial (Advantage 3-Tier). DOACs/warfarin open in blood thinners section [e.g. ELIQUIS, XARELTO, dabigatran, warfarin]

  • antiplatelets(Cigna)No PA

    Cigna commercial (Advantage 3-Tier). antiplatelets open [e.g. clopidogrel, prasugrel, ZONTIVITY]

  • pulmonary arterial hypertension(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). PAH agents in respiratory section, SP+PA [e.g. ADEMPAS, OPSUMIT, TRACLEER, TYVASO]

  • statins(Cigna)No PA

    Cigna commercial (Advantage 3-Tier). statins open (PPACA/QL); LIPOFEN/TRICOR fibrate=ST [e.g. atorvastatin, rosuvastatin, simvastatin, pravastatin]

  • pcsk9 inhibitors(Cigna)No PA

    Cigna commercial (Advantage 3-Tier). REPATHA listed without PA/ST in this plan [e.g. REPATHA]

  • beta blockers(Cigna)No PA

    Cigna commercial (Advantage 3-Tier). beta blockers open (QL only) [e.g. metoprolol er, carvedilol, atenolol, nebivolol]

  • pcsk9 inhibitors(Aetna (CVS Caremark))PA required

    Aetna (CVS Caremark) commercial formulary. specialty PSP; PA + step after statins standard [e.g. REPATHA (evolocumab), PRALUENT (alirocumab)]

  • arbs(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. ARBs + combos, open generics [e.g. losartan, valsartan, olmesartan, irbesartan]

  • pulmonary arterial hypertension(Aetna (CVS Caremark))PA required

    Aetna (CVS Caremark) commercial formulary. specialty PAH, PA standard [e.g. sildenafil (PAH), tadalafil (PAH), ambrisentan, bosentan]

  • beta blockers(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. beta-blockers + diuretic combos, open generics [e.g. metoprolol, carvedilol, atenolol, propranolol]

  • ace inhibitors(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. open generics incl ACE combos [e.g. lisinopril, enalapril, benazepril, ramipril]

  • statins(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. HMG-CoA reductase inhibitors, open generics [e.g. atorvastatin, rosuvastatin, simvastatin, pravastatin]

  • anticoagulants doac(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. anticoagulants/blood thinners, brand DOACs preferred; some ST [e.g. apixaban (ELIQUIS), rivaroxaban (XARELTO), warfarin, dabigatran]

  • antiplatelets(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. platelet aggregation inhibitors, open generics; BRILINTA brand [e.g. clopidogrel, prasugrel, ticagrelor (BRILINTA), aspirin-dipyridamole]

  • statins(Anthem Blue Cross (Elevance))No PA

    Anthem 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 PA

    Anthem Blue Cross (Elevance) commercial formulary. Alpha-beta/cardioselective/nonselective: QL only, open [e.g. metoprolol, carvedilol, atenolol, propranolol]

  • ace inhibitors(Anthem Blue Cross (Elevance))No PA

    Anthem Blue Cross (Elevance) commercial formulary. ACE inhibitors + combos: open [e.g. lisinopril, enalapril, benazepril, ramipril]

  • antiplatelets(Anthem Blue Cross (Elevance))No PA

    Anthem Blue Cross (Elevance) commercial formulary. P2Y12/thienopyridine/platelet inhibitors: QL only, open [e.g. clopidogrel, ticagrelor, prasugrel, dipyridamole]

  • pulmonary arterial hypertension(Anthem Blue Cross (Elevance))PA required

    Anthem Blue Cross (Elevance) commercial formulary. Prostaglandin vasodilators, endothelin receptor antagonists, PDE5, sGC stimulators: PA + SP [e.g. treprostinil, ambrisentan, tadalafil (ALYQ), ADEMPAS riociguat]

  • anticoagulants doac(Anthem Blue Cross (Elevance))PA required

    Anthem 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 required

    Anthem Blue Cross (Elevance) commercial formulary. PCSK9 inhibitors carry PA + QL [e.g. alirocumab, evolocumab (REPATHA/PRALUENT)]

  • arbs(Anthem Blue Cross (Elevance))No PA

    Anthem Blue Cross (Elevance) commercial formulary. Angiotensin II receptor antagonists + combos: QL only, open [e.g. losartan, valsartan, irbesartan, olmesartan]

part d
  • pulmonary arterial hypertension(Centene)PA required

    Centene Part D (CMS formulary file, plan-grounded).

  • beta blockers(Centene)No PA

    Centene Part D (CMS formulary file, plan-grounded).

  • antiplatelets(Centene)PA required

    Centene Part D (CMS formulary file, plan-grounded).

  • statins(Centene)No PA

    Centene Part D (CMS formulary file, plan-grounded).

  • anticoagulants doac(Centene)No PA

    Centene Part D (CMS formulary file, plan-grounded).

  • arbs(Centene)No PA

    Centene Part D (CMS formulary file, plan-grounded).

  • pcsk9 inhibitors(Centene)PA required

    Centene Part D (CMS formulary file, plan-grounded).

  • ace inhibitors(Centene)No PA

    Centene Part D (CMS formulary file, plan-grounded).

  • pulmonary arterial hypertension(Unitedhealthcare)PA required

    Unitedhealthcare Part D (CMS formulary file, plan-grounded).

  • anticoagulants doac(Unitedhealthcare)No PA

    Unitedhealthcare Part D (CMS formulary file, plan-grounded).

  • ace inhibitors(Unitedhealthcare)No PA

    Unitedhealthcare Part D (CMS formulary file, plan-grounded).

  • arbs(Unitedhealthcare)No PA

    Unitedhealthcare Part D (CMS formulary file, plan-grounded).

  • antiplatelets(Unitedhealthcare)PA required

    Unitedhealthcare Part D (CMS formulary file, plan-grounded).

  • beta blockers(Unitedhealthcare)No PA

    Unitedhealthcare Part D (CMS formulary file, plan-grounded).

  • statins(Unitedhealthcare)No PA

    Unitedhealthcare Part D (CMS formulary file, plan-grounded).

  • pcsk9 inhibitors(Unitedhealthcare)PA required

    Unitedhealthcare Part D (CMS formulary file, plan-grounded).

  • antiplatelets(Humana)PA required

    Humana Part D (CMS formulary file, plan-grounded).

  • beta blockers(Humana)No PA

    Humana Part D (CMS formulary file, plan-grounded).

  • statins(Humana)PA required

    Humana Part D (CMS formulary file, plan-grounded).

  • pcsk9 inhibitors(Humana)PA required

    Humana Part D (CMS formulary file, plan-grounded).

  • ace inhibitors(Humana)No PA

    Humana Part D (CMS formulary file, plan-grounded).

  • pulmonary arterial hypertension(Humana)PA required

    Humana Part D (CMS formulary file, plan-grounded).

  • anticoagulants doac(Humana)PA required

    Humana Part D (CMS formulary file, plan-grounded).

  • arbs(Humana)No PA

    Humana Part D (CMS formulary file, plan-grounded).

  • anticoagulants doac(Cigna)No PA

    Cigna Part D (CMS formulary file, plan-grounded).

  • arbs(Cigna)No PA

    Cigna Part D (CMS formulary file, plan-grounded).

  • pcsk9 inhibitors(Cigna)PA required

    Cigna Part D (CMS formulary file, plan-grounded).

  • pulmonary arterial hypertension(Cigna)PA required

    Cigna Part D (CMS formulary file, plan-grounded).

  • antiplatelets(Cigna)PA required

    Cigna Part D (CMS formulary file, plan-grounded).

  • ace inhibitors(Cigna)No PA

    Cigna Part D (CMS formulary file, plan-grounded).

  • statins(Cigna)No PA

    Cigna Part D (CMS formulary file, plan-grounded).

  • beta blockers(Cigna)No PA

    Cigna Part D (CMS formulary file, plan-grounded).

  • anticoagulants doac(Aetna)No PA

    Aetna Part D (CMS formulary file, plan-grounded).

  • pulmonary arterial hypertension(Aetna)PA required

    Aetna Part D (CMS formulary file, plan-grounded).

  • arbs(Aetna)No PA

    Aetna Part D (CMS formulary file, plan-grounded).

  • pcsk9 inhibitors(Aetna)PA required

    Aetna Part D (CMS formulary file, plan-grounded).

  • ace inhibitors(Aetna)No PA

    Aetna Part D (CMS formulary file, plan-grounded).

  • statins(Aetna)No PA

    Aetna Part D (CMS formulary file, plan-grounded).

  • beta blockers(Aetna)No PA

    Aetna Part D (CMS formulary file, plan-grounded).

  • antiplatelets(Aetna)PA required

    Aetna Part D (CMS formulary file, plan-grounded).

  • antiplatelets(Kaiser)PA required

    Kaiser Part D (CMS formulary file, plan-grounded).

  • pulmonary arterial hypertension(Kaiser)PA required

    Kaiser Part D (CMS formulary file, plan-grounded).

  • anticoagulants doac(Kaiser)No PA

    Kaiser Part D (CMS formulary file, plan-grounded).

  • arbs(Kaiser)No PA

    Kaiser Part D (CMS formulary file, plan-grounded).

  • statins(Kaiser)No PA

    Kaiser Part D (CMS formulary file, plan-grounded).

  • ace inhibitors(Kaiser)No PA

    Kaiser Part D (CMS formulary file, plan-grounded).

  • beta blockers(Kaiser)No PA

    Kaiser Part D (CMS formulary file, plan-grounded).

  • pcsk9 inhibitors(Kaiser)PA required

    Kaiser Part D (CMS formulary file, plan-grounded).

commercial qhp
  • antiplatelets(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. P2Y12, platelet-aggregation and PAR-1 inhibitors carry PA; thienopyridines open

  • pcsk9 inhibitors(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. 3 PA flags in PCSK9 inhibitor section

  • anticoagulants doac(Molina Healthcare)No PA

    Molina Healthcare commercial formulary. Eliquis/Xarelto (Direct Factor Xa) QL only, no PA/ST

  • statins(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. fluvastatin ER ST plus a PA; most statins open

  • pulmonary arterial hypertension(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. Prostaglandin vasodilators / PAH agents carry 14 PA

  • arbs(Molina Healthcare)No PA

    Molina Healthcare commercial formulary. Angiotensin II Receptor Antagonists section open

  • ace inhibitors(Molina Healthcare)No PA

    Molina Healthcare commercial formulary. ACE Inhibitors section open, no PA/ST

  • beta blockers(Molina Healthcare)No PA

    Molina Healthcare commercial formulary. Cardioselective/non-selective/alpha-beta blockers all open

If denied in Washington
📨 Office of Administrative Hearings (OAH)
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Full criteria, sources & appeal paths — all 51 states.

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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.