Auth57 · Specialty PA Pack

Endocrinology

For the endocrinologist on GLP-1s, insulin, and growth hormone — where PA bites, and exactly how to clear it.

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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	Approved · CY25	Rules	PA-required	Appeal	Criteria docs
● Recent · CY2025 disclosures — click a state to drill in
WAWashington▸ viewing	88.2%	36	78%	✓	11
COColorado	91.8%	33	79%	✓	6
OHOhio	77.7%	36	81%	✓	15
All states · A–Z
AKAlaska	—	21	86%	✓	4
ALAlabama	—	33	82%	✓	6
ARArkansas	—	36	81%	✓	8
AZArizona	—	33	82%	✓	5
CACalifornia	—	36	78%	✓	11
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
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
WIWisconsin	—	33	82%	✓	2
WVWest Virginia	—	27	85%	✓	2
WYWyoming	—	24	83%	✓	9

Deep dive· Washington

Washington — endocrinology, 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%

growth hormonePA required
WA Medicaid PDL: non-preferred agents in this class require PA.
glp1 agonistsPA required
WA Medicaid PDL: non-preferred agents in this class require PA.
insulinsPA required
WA Medicaid PDL: non-preferred agents in this class require PA.

commercial regulated

insulins(UnitedHealthcare)PA required
UnitedHealthcare 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]
glp1 agonists(UnitedHealthcare)PA required
UnitedHealthcare 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]
growth hormone(UnitedHealthcare)PA required
UnitedHealthcare 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 PA
Cigna commercial (Advantage 3-Tier). insulins open, QL only [e.g. LANTUS, HUMALOG, TRESIBA, INSULIN LISPRO]
growth hormone(Cigna)PA required
Cigna commercial (Advantage 3-Tier). somatropins SP+PA in hormonal agents section [e.g. GENOTROPIN, OMNITROPE, NGENLA, NorditropI]
glp1 agonists(Cigna)PA required
Cigna commercial (Advantage 3-Tier). GLP-1 agonists carry PA+QL [e.g. OZEMPIC, MOUNJARO, TRULICITY, RYBELSUS]
insulins(Aetna (CVS Caremark))No PA
Aetna (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 required
Aetna (CVS Caremark) commercial formulary. human growth hormones, specialty PA [e.g. somatropin (NORDITROPIN, GENOTROPIN, HUMATROPE)]
glp1 agonists(Aetna (CVS Caremark))PA required
Aetna (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 required
Anthem Blue Cross (Elevance) commercial formulary. Incretin mimetic GLP-1 receptor agonists: PA + QL [e.g. liraglutide, dulaglutide, exenatide]
insulins(Anthem Blue Cross (Elevance))PA required
Anthem 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 required
Anthem Blue Cross (Elevance) commercial formulary. Growth hormones: PA + SP (some ST) [e.g. OMNITROPE somatropin, growth hormones]

part d

growth hormone(Centene)PA required
Centene Part D (CMS formulary file, plan-grounded).
glp1 agonists(Centene)PA required
Centene Part D (CMS formulary file, plan-grounded).
insulins(Centene)No PA
Centene Part D (CMS formulary file, plan-grounded).
growth hormone(Unitedhealthcare)PA required
Unitedhealthcare Part D (CMS formulary file, plan-grounded).
insulins(Unitedhealthcare)No PA
Unitedhealthcare Part D (CMS formulary file, plan-grounded).
glp1 agonists(Unitedhealthcare)PA required
Unitedhealthcare Part D (CMS formulary file, plan-grounded).
insulins(Humana)No PA
Humana Part D (CMS formulary file, plan-grounded).
glp1 agonists(Humana)PA required
Humana Part D (CMS formulary file, plan-grounded).
growth hormone(Humana)PA required
Humana Part D (CMS formulary file, plan-grounded).
growth hormone(Cigna)PA required
Cigna Part D (CMS formulary file, plan-grounded).
glp1 agonists(Cigna)PA required
Cigna Part D (CMS formulary file, plan-grounded).
insulins(Cigna)No PA
Cigna Part D (CMS formulary file, plan-grounded).
growth hormone(Aetna)PA required
Aetna Part D (CMS formulary file, plan-grounded).
insulins(Aetna)PA required
Aetna Part D (CMS formulary file, plan-grounded).
glp1 agonists(Aetna)PA required
Aetna Part D (CMS formulary file, plan-grounded).
insulins(Kaiser)No PA
Kaiser Part D (CMS formulary file, plan-grounded).
growth hormone(Kaiser)PA required
Kaiser Part D (CMS formulary file, plan-grounded).
glp1 agonists(Kaiser)PA required
Kaiser Part D (CMS formulary file, plan-grounded).

commercial qhp

glp1 agonists(Molina Healthcare)PA required
Molina Healthcare commercial formulary. Ozempic/Trulicity/Rybelsus/liraglutide all carry ST
insulins(Molina Healthcare)No PA
Molina Healthcare commercial formulary. Human Insulin section only QL/MAIL/$35 cap, no PA/ST
growth hormone(Molina Healthcare)PA required
Molina Healthcare commercial formulary. Growth Hormones section 4 PA flags

If denied in Washington

📨 Office of Administrative Hearings (OAH)

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.