← All packs
Infectious Disease care
Auth57 · Specialty PA Pack

Infectious Disease

For the ID specialist on antiretrovirals, Hep C, and antifungals — prior auth and appeals, mapped nationwide.

Unlock all 51 states →See a free state →
Structured rules
1,835
PA-required
63%
Appeal layer
51/51
Criteria docs
51/51
The breadth · all 51 jurisdictions

Every state, quantified for infectious disease

StateApproved · CY25RulesPA-requiredAppealCriteria docs
● Recent · CY2025 disclosures — click a state to drill in
WAWashington▸ viewing88.2%4156%✓16
COColorado91.8%3861%✓15
OHOhio77.7%4271%✓29
All states · A–Z
AKAlaska—2665%✓5
ALAlabama—3866%✓10
ARArkansas—4065%✓13
AZArizona—3866%✓12
CACalifornia—4055%✓7
CTConnecticut—3866%✓4
DCDistrict of Columbia—3861%✓12
DEDelaware—3866%✓7
FLFlorida—3866%✓7
GAGeorgia—4163%✓34
HIHawaii—3858%✓11
IAIowa—3866%✓18
IDIdaho—2962%✓12
ILIllinois—3866%✓6
INIndiana—3868%✓10
KSKansas—3765%✓13
KYKentucky—4166%✓6
LALouisiana—3566%✓18
MAMassachusetts—3263%✓6
MDMaryland—3459%✓25
MEMaine—3462%✓7
MIMichigan—3560%✓23
MNMinnesota—2959%✓15
MOMissouri—4367%✓6
MSMississippi—4065%✓16
MTMontana—2966%✓6
NCNorth Carolina—4163%✓47
NDNorth Dakota—2861%✓8
NENebraska—3566%✓6
NHNew Hampshire—3465%✓3
NJNew Jersey—3560%✓9
NMNew Mexico—3060%✓9
NVNevada—3462%✓28
NYNew York—3964%✓26
OKOklahoma—4163%✓10
OROregon—4163%✓6
PAPennsylvania—3563%✓19
RIRhode Island—2962%✓4
SCSouth Carolina—3866%✓13
SDSouth Dakota—2756%✓4
TNTennessee—3866%✓10
TXTexas—4060%✓97
UTUtah—3866%✓26
VAVirginia—4163%✓22
VTVermont—2662%✓18
WIWisconsin—3868%✓10
WVWest Virginia—3266%✓1
WYWyoming—2966%✓10
Deep dive· Washington

Washington — infectious disease, 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.
  • antifungals systemicPA required

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

  • hepatitis c daaPA required

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

  • hiv antiretrovirals(HCA Washington)No PAstep therapy

    CORRECTED 2026-06-07: WA Apple Health covers all HIV treatment + PrEP WITHOUT prior authorization since 2023-01-01 (HCA legislative report). HIV is a protected class.

medicaid mco
Approved · CMS-0057-F 202588.2%across 4 payers (81.2–93.1%)
Draft · aggregatedSource ↗
  • hiv antiretrovirals(HCA Washington)No PAstep therapy

    CORRECTED 2026-06-07: WA Apple Health covers all HIV treatment + PrEP WITHOUT prior authorization since 2023-01-01 (HCA legislative report). HIV is a protected class.

medicare advantage
  • hiv antiretroviralsNo PA

    CORRECTED 2026-06-07: WA Apple Health covers all HIV treatment + PrEP WITHOUT prior authorization since 2023-01-01 (HCA legislative report). HIV is a protected class.

dual eligible
  • hiv antiretroviralsNo PA

    CORRECTED 2026-06-07: WA Apple Health covers all HIV treatment + PrEP WITHOUT prior authorization since 2023-01-01 (HCA legislative report). HIV is a protected class.

part d
  • hiv antiretroviralsNo PA

    FEDERAL PROTECTED CLASS. Broad access required — no restrictive PA.

  • antifungals systemic(Centene)PA required

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

  • hepatitis c daa(Centene)PA required

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

  • hiv antiretrovirals(Centene)No PA

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

  • antifungals systemic(Unitedhealthcare)PA required

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

  • hepatitis c daa(Unitedhealthcare)PA required

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

  • hiv antiretrovirals(Unitedhealthcare)No PA

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

  • antifungals systemic(Humana)PA required

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

  • hepatitis c daa(Humana)PA required

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

  • hiv antiretrovirals(Humana)No PA

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

  • hiv antiretrovirals(Cigna)No PA

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

  • antifungals systemic(Cigna)PA required

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

  • hepatitis c daa(Cigna)PA required

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

  • hiv antiretrovirals(Aetna)No PA

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

  • antifungals systemic(Aetna)PA required

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

  • hepatitis c daa(Aetna)PA required

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

  • hiv antiretrovirals(Kaiser)No PA

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

  • antifungals systemic(Kaiser)No PA

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

  • hepatitis c daa(Kaiser)PA required

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

medicare traditional
  • hiv antiretroviralsNo PA

    Oral drugs under Part D PDP — no FFS Part B PA. IV/infused drugs Part B — no PA under FFS.

commercial regulated
  • antifungals systemic(UnitedHealthcare)PA required

    UnitedHealthcare commercial (Advantage 3-Tier). Antifungals-fungal infections; mostly QL but JUBLIA (PA,ST) and VIVJOA (PA) carry PA [e.g. fluconazole, itraconazole, terbinafine, JUBLIA]

  • hiv antiretrovirals(UnitedHealthcare)No PA

    UnitedHealthcare commercial (Advantage 3-Tier). HIV ARVs within Antivirals heading; carry QL only (no PA); tenofovir DF carries H-PA preventive/PrEP flag, not standard PA [e.g. BIKTARVY, DOVATO, GENVOYA, TRIUMEQ]

  • hepatitis c daa(UnitedHealthcare)PA required

    UnitedHealthcare commercial (Advantage 3-Tier). Hep C DAAs within Antivirals heading; all carry PA+QL+SP (HARVONI/LEDIPASVIR-SOFOSBUVIR add ST) [e.g. EPCLUSA, HARVONI, MAVYRET, VOSEVI]

  • antifungals systemic(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). oral azoles mostly open; CRESEMBA/VIVJOA carry PA [e.g. fluconazole, itraconazole, CRESEMBA, VIVJOA]

  • hiv antiretrovirals(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). AIDS/HIV section; several agents carry PA (others SP/QL only) [e.g. CABENUVA, DELSTRIGO, STRIBILD, PIFELTRO]

  • hepatitis c daa(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). HCV direct-acting antivirals SP+PA [e.g. EPCLUSA, HARVONI, VOSEVI, ZEPATIER]

  • hiv antiretrovirals(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. protected class; standard tiers, generally no PA [e.g. BIKTARVY, TRIUMEQ, DOVATO, TIVICAY]

  • antifungals systemic(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. oral antifungals; some brands ST [e.g. fluconazole, itraconazole, terbinafine, posaconazole]

  • hepatitis c daa(Aetna (CVS Caremark))PA required

    Aetna (CVS Caremark) commercial formulary. HCV DAAs, specialty, PA standard [e.g. MAVYRET, EPCLUSA, sofosbuvir-velpatasvir, ZEPATIER]

  • antifungals systemic(Anthem Blue Cross (Elevance))PA required

    Anthem Blue Cross (Elevance) commercial formulary. Triazoles + glucan synthesis inhibitors carry PA; imidazoles open [e.g. BREXAFEMME ibrexafungerp, voriconazole, posaconazole (triazoles)]

  • hepatitis c daa(Anthem Blue Cross (Elevance))PA required

    Anthem Blue Cross (Elevance) commercial formulary. Hepatitis C agents + combinations: PA + SP [e.g. EPCLUSA sofosbuvir-velpatasvir, PEGASYS peginterferon]

  • hiv antiretrovirals(Anthem Blue Cross (Elevance))No PA

    Anthem Blue Cross (Elevance) commercial formulary. All HIV antiretroviral subclasses (combos, integrase, protease, NNRTI, NRTI, NRTI-nucleotide, CCR5, fusion) carry QL only - NO PA, NO ST; open [e.g. abacavir-lamivudine, raltegravir (ISENTRESS), emtricitabine, tenofovir DF]

commercial qhp
  • hiv antiretrovirals(Molina Healthcare)No PA

    Molina Healthcare commercial formulary. All ARV subsections (combos/integrase/protease/NNRTI/NRTI) QL/AGE only, no PA/ST

  • hepatitis c daa(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. Hep C agents and combinations carry PA

  • antifungals systemic(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. Systemic triazole and one antifungal carry PA

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 Infectious Diseasepack — every state’s criteria, source citations, and step-by-step appeal instructions — is one email away.

We'll never sell or share your email.

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