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Psychiatry / Behavioral Health care
Auth57 · Specialty PA Pack

Psychiatry / Behavioral Health

For the psychiatrist prescribing stimulants, antipsychotics, and antidepressants — coverage and appeals, every plan.

Unlock all 51 states →See a free state →
Structured rules
3,219
PA-required
70%
Appeal layer
51/51
Criteria docs
48/51
The breadth · all 51 jurisdictions

Every state, quantified for psychiatry / behavioral health

StateApproved · CY25RulesPA-requiredAppealCriteria docs
● Recent · CY2025 disclosures — click a state to drill in
WAWashington▸ viewing88.2%7373%✓9
COColorado91.8%6766%✓3
OHOhio77.7%7474%✓23
All states · A–Z
AKAlaska—4468%✓2
ALAlabama—6572%✓12
ARArkansas—7473%✓3
AZArizona—6874%✓9
CACalifornia—7462%✓18
CTConnecticut—6671%✓2
DCDistrict of Columbia—6766%✓11
DEDelaware—6773%✓3
FLFlorida—6872%✓4
GAGeorgia—7464%✓27
HIHawaii—6863%✓11
IAIowa—6872%✓7
IDIdaho—5066%✓4
ILIllinois—6671%✓4
INIndiana—6472%✓7
KSKansas—6572%✓15
KYKentucky—7473%✓5
LALouisiana—6070%✓10
MAMassachusetts—5670%✓17
MDMaryland—5963%✓12
MEMaine—6170%✓4
MIMichigan—6263%✓11
MNMinnesota—4967%✓1
MOMissouri—7674%✓8
MSMississippi—7373%✓12
MTMontana—4766%✓3
NCNorth Carolina—7374%✓33
NDNorth Dakota—4768%✓3
NENebraska—5869%✓2
NHNew Hampshire—6172%✓—
NJNew Jersey—6067%✓3
NMNew Mexico—5165%✓8
NVNevada—6271%✓33
NYNew York—6872%✓9
OKOklahoma—7474%✓—
OROregon—7168%✓7
PAPennsylvania—6271%✓19
RIRhode Island—4969%✓—
SCSouth Carolina—6772%✓5
SDSouth Dakota—4564%✓2
TNTennessee—6773%✓7
TXTexas—7473%✓59
UTUtah—6874%✓15
VAVirginia—7166%✓17
VTVermont—4262%✓4
WIWisconsin—6773%✓2
WVWest Virginia—5571%✓1
WYWyoming—4865%✓8
Deep dive· Washington

Washington — psychiatry / behavioral health, 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 mco
Approved · CMS-0057-F 202588.2%across 4 payers (81.2–93.1%)
Draft · aggregatedSource ↗
  • adhd stimulantsPA requiredstep therapy

    ADHD diagnosisAdult patient

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.
  • adhd stimulantsPA requiredstep therapy

    ADHD stimulants require PA for adults. Generics preferred; brand/XR may require step.

  • atypical antipsychoticsPA required

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

  • ssri antidepressantsPA required

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

  • anticonvulsantsPA required

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

  • other antidepressantsPA required

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

dual eligible
  • adhd stimulants(MA Part D)PA required

    Part D primary. Brand/non-preferred stimulants may require PA under MA Part D. LIS eliminates cost-sharing.

medicare traditional
  • adhd stimulantsNo PA

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

medicare advantage
  • adhd stimulantsPA required

    Brand/non-preferred stimulants may require PA under MA Part D.

part d
  • adhd stimulantsPA required

    Brand/non-preferred stimulants require PA on Part D.

  • anxiolytics benzodiazepines(Centene)PA required

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

  • anticonvulsants(Centene)PA required

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

  • ssri antidepressants(Centene)No PA

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

  • other antidepressants(Centene)PA required

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

  • adhd stimulants(Centene)PA required

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

  • atypical antipsychotics(Centene)PA required

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

  • other antidepressants(Unitedhealthcare)PA required

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

  • atypical antipsychotics(Unitedhealthcare)PA required

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

  • anxiolytics benzodiazepines(Unitedhealthcare)PA required

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

  • adhd stimulants(Unitedhealthcare)PA required

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

  • anticonvulsants(Unitedhealthcare)PA required

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

  • ssri antidepressants(Unitedhealthcare)No PA

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

  • other antidepressants(Humana)PA required

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

  • adhd stimulants(Humana)No PA

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

  • anticonvulsants(Humana)PA required

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

  • ssri antidepressants(Humana)No PA

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

  • atypical antipsychotics(Humana)PA required

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

  • anxiolytics benzodiazepines(Humana)PA required

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

  • other antidepressants(Cigna)PA required

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

  • atypical antipsychotics(Cigna)PA required

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

  • anticonvulsants(Cigna)PA required

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

  • adhd stimulants(Cigna)PA required

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

  • anxiolytics benzodiazepines(Cigna)PA required

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

  • ssri antidepressants(Cigna)No PA

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

  • adhd stimulants(Aetna)PA required

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

  • atypical antipsychotics(Aetna)PA required

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

  • anticonvulsants(Aetna)PA required

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

  • anxiolytics benzodiazepines(Aetna)PA required

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

  • ssri antidepressants(Aetna)PA required

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

  • other antidepressants(Aetna)PA required

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

  • other antidepressants(Kaiser)PA required

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

  • adhd stimulants(Kaiser)PA required

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

  • anxiolytics benzodiazepines(Kaiser)No PA

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

  • anticonvulsants(Kaiser)PA required

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

  • ssri antidepressants(Kaiser)PA required

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

  • atypical antipsychotics(Kaiser)PA required

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

commercial regulated
  • anticonvulsants(UnitedHealthcare)PA required

    UnitedHealthcare commercial (Advantage 3-Tier). Anticonvulsants-seizures; many brand agents carry PA (APTIOM, KEPPRA, TOPAMAX, VIMPAT, XCOPRI); EPIDIOLEX PA+SP [e.g. APTIOM, BRIVIACT, DEPAKOTE, KEPPRA]

  • atypical antipsychotics(UnitedHealthcare)PA required

    UnitedHealthcare commercial (Advantage 3-Tier). Antipsychotics-mood disorders; generics QL only but CAPLYTA carries PA+ST+QL; brands REXULTI/VRAYLAR QL [e.g. aripiprazole, risperidone, quetiapine, CAPLYTA]

  • anxiolytics benzodiazepines(UnitedHealthcare)No PA

    UnitedHealthcare commercial (Advantage 3-Tier). Anxiolytics-anxiety; all tier 1, no PA/ST/QL [e.g. alprazolam, lorazepam, clonazepam, buspirone]

  • adhd stimulants(UnitedHealthcare)PA required

    UnitedHealthcare commercial (Advantage 3-Tier). CNS-attention deficit; generics QL but AZSTARYS/JORNAY PM (ST,QL) and XELSTRYM (PA,QL) carry step/PA [e.g. amphetamine-dextroamphetamine, methylphenidate, lisdexamfetamine, AZSTARYS]

  • anxiolytics benzodiazepines(Cigna)No PA

    Cigna commercial (Advantage 3-Tier). benzodiazepines/buspirone open in anxiety section [e.g. alprazolam, lorazepam, buspirone]

  • other antidepressants(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). mixed; AUVELITY=ST, ZURZUVAE/NUPLAZID=PA [e.g. AUVELITY, ZURZUVAE, NUPLAZID, bupropion]

  • adhd stimulants(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). ADHD stimulants broadly carry PA (incl generics) [e.g. methylphenidate, lisdexamfetamine, dextroamphetamine-amphetamine, AZSTARYS]

  • ssri antidepressants(Cigna)No PA

    Cigna commercial (Advantage 3-Tier). SSRIs open, QL only [e.g. fluoxetine, sertraline, escitalopram, paroxetine]

  • atypical antipsychotics(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). generic atypicals open (QL); SECUADO=ST [e.g. aripiprazole, risperidone, quetiapine, CAPLYTA]

  • anticonvulsants(Cigna)PA required

    Cigna commercial (Advantage 3-Tier). generic AEDs open; branded (BRIVIACT/DILANTIN/OXTELLAR/XCOPRI/SPRITAM/TEGRETOL XR)=PA [e.g. gabapentin, lamotrigine, levetiracetam, topiramate]

  • other antidepressants(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. single ANTIDEPRESSANTS heading covers SSRI/SNRI/other; open generics, some brands ST [e.g. sertraline, escitalopram, fluoxetine, venlafaxine]

  • atypical antipsychotics(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. oral generics open; LAI injectables specialty PA [e.g. aripiprazole, quetiapine, risperidone, ABILIFY MAINTENA]

  • adhd stimulants(Aetna (CVS Caremark))PA required

    Aetna (CVS Caremark) commercial formulary. stimulants carry QL/PA (age/quantity edits) [e.g. amphetamine salts, methylphenidate, lisdexamfetamine (VYVANSE)]

  • anxiolytics benzodiazepines(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. benzodiazepines, QL but open generics [e.g. alprazolam, lorazepam, clonazepam, diazepam]

  • anticonvulsants(Aetna (CVS Caremark))No PA

    Aetna (CVS Caremark) commercial formulary. antiseizure agents, open generics; some brands ST [e.g. levetiracetam, lamotrigine, topiramate, gabapentin]

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

    Anthem Blue Cross (Elevance) commercial formulary. All anticonvulsant subclasses: QL only, no PA; open [e.g. levetiracetam, lamotrigine, carbamazepine er, divalproex]

  • adhd stimulants(Anthem Blue Cross (Elevance))PA required

    Anthem Blue Cross (Elevance) commercial formulary. All ADHD agents (amphetamines, mixtures, alpha-agonists, SNRI) carry PA [e.g. amphetamine-dextroamphetamine, lisdexamfetamine, dextroamphetamine, atomoxetine]

  • anxiolytics benzodiazepines(Anthem Blue Cross (Elevance))No PA

    Anthem Blue Cross (Elevance) commercial formulary. Antianxiety + benzodiazepines: QL only, open [e.g. alprazolam, lorazepam, buspirone, diazepam]

  • ssri antidepressants(Anthem Blue Cross (Elevance))No PA

    Anthem Blue Cross (Elevance) commercial formulary. SSRIs: no PA, open [e.g. citalopram, sertraline, fluoxetine, escitalopram]

  • atypical antipsychotics(Anthem Blue Cross (Elevance))PA required

    Anthem Blue Cross (Elevance) commercial formulary. Antipsychotics/antimanic subclasses carry PA + QL [e.g. aripiprazole, olanzapine, quetiapine, risperidone]

  • other antidepressants(Anthem Blue Cross (Elevance))No PA

    Anthem Blue Cross (Elevance) commercial formulary. Misc/serotonin modulators/TCA/MAOI/tetracyclic: QL only, open [e.g. bupropion, mirtazapine, nefazodone, amitriptyline]

commercial qhp
  • ssri antidepressants(Molina Healthcare)No PA

    Molina Healthcare commercial formulary. SSRI section open, QL only

  • other antidepressants(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. vilazodone and Trintellix (vortioxetine) carry PA; bupropion open

  • adhd stimulants(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. Several amphetamines and stimulants-misc carry PA; alpha-agonist ER PA

  • anticonvulsants(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. 2 PA flags across anticonvulsants block

  • atypical antipsychotics(Molina Healthcare)PA required

    Molina Healthcare commercial formulary. paliperidone ER, aripiprazole ODT and others carry PA

  • anxiolytics benzodiazepines(Molina Healthcare)No PA

    Molina Healthcare commercial formulary. Antianxiety-misc and benzodiazepine sections 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.