Auth57 · Specialty PA Pack

Urology

For the urologist on overactive-bladder and testosterone therapy — the PA and appeal map for every payer.

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Structured rules

1,044

PA-required

66%

Appeal layer

51/51

Criteria docs

46/51

The breadth · all 51 jurisdictions

Every state, quantified for urology

State	Approved · CY25	Rules	PA-required	Appeal	Criteria docs
● Recent · CY2025 disclosures — click a state to drill in
WAWashington▸ viewing	88.2%	24	58%	✓	3
COColorado	91.8%	22	59%	✓	3
OHOhio	77.7%	24	67%	✓	5
All states · A–Z
AKAlaska	—	14	86%	✓	1
ALAlabama	—	21	67%	✓	2
ARArkansas	—	24	67%	✓	2
AZArizona	—	22	68%	✓	2
CACalifornia	—	24	54%	✓	4
CTConnecticut	—	22	68%	✓	2
DCDistrict of Columbia	—	21	57%	✓	6
DEDelaware	—	22	68%	✓	3
FLFlorida	—	22	64%	✓	1
GAGeorgia	—	24	58%	✓	4
HIHawaii	—	22	59%	✓	1
IAIowa	—	22	68%	✓	5
IDIdaho	—	16	69%	✓	1
ILIllinois	—	20	65%	✓	3
INIndiana	—	21	67%	✓	1
KSKansas	—	22	68%	✓	3
KYKentucky	—	24	63%	✓	4
LALouisiana	—	20	75%	✓	8
MAMassachusetts	—	18	67%	✓	5
MDMaryland	—	20	60%	✓	5
MEMaine	—	20	65%	✓	2
MIMichigan	—	20	70%	✓	8
MNMinnesota	—	16	75%	✓	2
MOMissouri	—	24	63%	✓	—
MSMississippi	—	24	67%	✓	1
MTMontana	—	15	80%	✓	2
NCNorth Carolina	—	24	67%	✓	1
NDNorth Dakota	—	15	67%	✓	—
NENebraska	—	20	70%	✓	2
NHNew Hampshire	—	20	70%	✓	1
NJNew Jersey	—	20	65%	✓	2
NMNew Mexico	—	16	63%	✓	—
NVNevada	—	20	65%	✓	2
NYNew York	—	22	64%	✓	8
OKOklahoma	—	24	67%	✓	1
OROregon	—	24	63%	✓	3
PAPennsylvania	—	20	65%	✓	10
RIRhode Island	—	16	69%	✓	—
SCSouth Carolina	—	22	73%	✓	2
SDSouth Dakota	—	14	64%	✓	1
TNTennessee	—	21	67%	✓	4
TXTexas	—	24	67%	✓	18
UTUtah	—	22	68%	✓	5
VAVirginia	—	23	57%	✓	6
VTVermont	—	13	77%	✓	—
WIWisconsin	—	21	67%	✓	2
WVWest Virginia	—	17	76%	✓	1
WYWyoming	—	16	81%	✓	4

Deep dive· Washington

Washington — urology, 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%

testosterone androgensPA required
WA Medicaid PDL: non-preferred agents in this class require PA.
overactive bladderPA required
WA Medicaid PDL: non-preferred agents in this class require PA.

commercial regulated

overactive bladder(UnitedHealthcare)PA required
UnitedHealthcare commercial (Advantage 3-Tier). Genitourinary-bladder/genital/kidney; OAB generics open, but mirabegron/ELMIRON/VELPHORO carry ST and VANRAFIA carries PA+QL+SP, TEZRULY PA [e.g. oxybutynin, solifenacin, mirabegron, tolterodine]
testosterone androgens(UnitedHealthcare)PA required
UnitedHealthcare commercial (Advantage 3-Tier). Hormonal-testosterone replacement; topical gels and brands (KYZATREX, TESTIM) carry PA+QL; injectables open [e.g. testosterone gel, testosterone cypionate, KYZATREX, TESTIM]
overactive bladder(Cigna)PA required
Cigna commercial (Advantage 3-Tier). urinary tract; OAB generics open (QL), VANRAFIA SP+PA [e.g. oxybutynin er, mirabegron er, solifenacin, tolterodine er]
testosterone androgens(Cigna)PA required
Cigna commercial (Advantage 3-Tier). androgens carry PA+QL (DEPO-TESTOSTERONE open) [e.g. testosterone gel, XYOSTED, DEPO-TESTOSTERONE, testosterone cypionate]
testosterone androgens(Aetna (CVS Caremark))PA required
Aetna (CVS Caremark) commercial formulary. androgens, PA/ST (lab + diagnosis edits) [e.g. testosterone cypionate, testosterone gel, ANDRODERM]
overactive bladder(Aetna (CVS Caremark))No PA
Aetna (CVS Caremark) commercial formulary. urinary antispasmodics, open generics; brands ST [e.g. oxybutynin, tolterodine, mirabegron (MYRBETRIQ), solifenacin]
testosterone androgens(Anthem Blue Cross (Elevance))PA required
Anthem Blue Cross (Elevance) commercial formulary. Androgens for men carry PA [e.g. danazol, testosterone (androgens)]
overactive bladder(Anthem Blue Cross (Elevance))No PA
Anthem Blue Cross (Elevance) commercial formulary. Urinary antispasmodics (antimuscarinics): QL only, NO PA; open [e.g. oxybutynin, tolterodine, trospium, solifenacin]

part d

overactive bladder(Centene)No PA
Centene Part D (CMS formulary file, plan-grounded).
testosterone androgens(Centene)PA required
Centene Part D (CMS formulary file, plan-grounded).
testosterone androgens(Unitedhealthcare)No PA
Unitedhealthcare Part D (CMS formulary file, plan-grounded).
overactive bladder(Unitedhealthcare)No PA
Unitedhealthcare Part D (CMS formulary file, plan-grounded).
testosterone androgens(Humana)PA required
Humana Part D (CMS formulary file, plan-grounded).
overactive bladder(Humana)No PA
Humana Part D (CMS formulary file, plan-grounded).
overactive bladder(Cigna)No PA
Cigna Part D (CMS formulary file, plan-grounded).
testosterone androgens(Cigna)PA required
Cigna Part D (CMS formulary file, plan-grounded).
testosterone androgens(Aetna)PA required
Aetna Part D (CMS formulary file, plan-grounded).
overactive bladder(Aetna)No PA
Aetna Part D (CMS formulary file, plan-grounded).
testosterone androgens(Kaiser)No PA
Kaiser Part D (CMS formulary file, plan-grounded).
overactive bladder(Kaiser)No PA
Kaiser Part D (CMS formulary file, plan-grounded).

commercial qhp

overactive bladder(Molina Healthcare)PA required
Molina Healthcare commercial formulary. Urinary antispasmodics carry 7 ST + 2 PA
testosterone androgens(Molina Healthcare)PA required
Molina Healthcare commercial formulary. methyltestosterone PA+age; testosterone esters QL only

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 Urologypack — 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.