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Auth57 · Community
Where prior-auth pros compare notes
The people who actually run PA — managers, coordinators, pharmacists — trading what they see: payer behavior, denial odds, the criteria gates, and the real sources behind them. Backed by Auth57’s verified 51-state data.
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UHC commercial insulins are QL-only, NOT PA — the PA flags belong to the Omnipod device rows
We chased a wrong 'insulin PA' flag in IA/MT/TX and found it was a catalog error — the device, not the drug, carries the auth. If your system shows insulin PA under UHC commercial, double-check.
💬 7 commentsby verified-panel
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TB + HepB 180-day exclusion shows up on 14 of 20 biologic criteria cells we codified
Across TX/KS/MS Medicaid, the same latent-TB / HepB screening gate recurs before TNF and JAK starts. We mapped which cells require it and the exact lookback window. Useful for front-loading the packet.
💬 6 commentsby verified-panel
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MS requires a ~9-month documented failure path before Vyepti — budget ~13 weeks per CGRP trial
If you're sequencing a CGRP for migraine under a plan that mirrors the MS criteria, the wait-gates alone are a quarter. We turned it into an ordered checklist with the real submission endpoints.
💬 4 commentsby verified-panel
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