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Endocrinology care
Auth57 · Specialty PA Pack

Endocrinology

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

Unlock all 51 states →See a free state →
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

StateApproved · CY25RulesPA-requiredAppealCriteria docs
● Recent · CY2025 disclosures — click a state to drill in
WAWashington▸ viewing88.2%3678%✓11
COColorado91.8%3379%✓6
OHOhio77.7%3681%✓15
All states · A–Z
AKAlaska—2186%✓4
ALAlabama—3382%✓6
ARArkansas—3681%✓8
AZArizona—3382%✓5
CACalifornia—3678%✓11
CTConnecticut—3379%✓11
DCDistrict of Columbia—3379%✓8
DEDelaware—3382%✓4
FLFlorida—3382%✓4
GAGeorgia—3678%✓20
HIHawaii—3376%✓9
IAIowa—3382%✓13
IDIdaho—2479%✓10
ILIllinois—3281%✓2
INIndiana—3382%✓8
KSKansas—3382%✓11
KYKentucky—3678%✓4
LALouisiana—3083%✓17
MAMassachusetts—2781%✓14
MDMaryland—3080%✓22
MEMaine—3080%✓4
MIMichigan—3083%✓13
MNMinnesota—2483%✓2
MOMissouri—3879%✓5
MSMississippi—3681%✓9
MTMontana—2483%✓4
NCNorth Carolina—3681%✓31
NDNorth Dakota—2483%✓8
NENebraska—3083%✓4
NHNew Hampshire—3083%✓—
NJNew Jersey—3080%✓3
NMNew Mexico—2475%✓5
NVNevada—2979%✓22
NYNew York—3379%✓9
OKOklahoma—3681%✓3
OROregon—3681%✓3
PAPennsylvania—3080%✓23
RIRhode Island—2483%✓3
SCSouth Carolina—3281%✓6
SDSouth Dakota—2181%✓3
TNTennessee—3382%✓6
TXTexas—3681%✓54
UTUtah—3382%✓16
VAVirginia—3678%✓20
VTVermont—2181%✓8
WIWisconsin—3382%✓2
WVWest Virginia—2785%✓2
WYWyoming—2483%✓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%
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.
  • growth hormonePA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonistsPA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulinsPA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
commercial regulated
  • insulins(UnitedHealthcare)PA required
    Switch?PA + step therapy — a prior in-class trial usually clears it
    This plan gates the class with PA + quantity limit + step therapy. A documented trial (or failure/intolerance) of an in-class agent — which your patient already has — typically satisfies the step requirement, so the switch clears.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(UnitedHealthcare)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA + quantity limit. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(UnitedHealthcare)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA + quantity limit + specialty pharmacy. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Cigna)No PA
    Switch?Switch usually clears — no PA
    No prior authorization on this plan for this class — document the clinical reason for the change.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Cigna)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA + specialty pharmacy. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Cigna)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA + quantity limit. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Aetna (CVS Caremark))No PA
    Switch?Switch usually clears — no PA
    No prior authorization on this plan for this class — document the clinical reason for the change.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Aetna (CVS Caremark))PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA + specialty pharmacy. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Aetna (CVS Caremark))PA required
    Switch?PA + step therapy — a prior in-class trial usually clears it
    This plan gates the class with PA + step therapy. A documented trial (or failure/intolerance) of an in-class agent — which your patient already has — typically satisfies the step requirement, so the switch clears.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Anthem Blue Cross (Elevance))PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA + quantity limit. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Anthem Blue Cross (Elevance))PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA + quantity limit. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Anthem Blue Cross (Elevance))PA required
    Switch?PA + step therapy — a prior in-class trial usually clears it
    This plan gates the class with PA + specialty pharmacy + step therapy. A documented trial (or failure/intolerance) of an in-class agent — which your patient already has — typically satisfies the step requirement, so the switch clears.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
part d
  • growth hormone(Centene)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Centene)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Centene)No PA
    Switch?Switch usually clears — no PA
    No prior authorization on this plan for this class — document the clinical reason for the change.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Unitedhealthcare)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Unitedhealthcare)No PA
    Switch?Switch usually clears — no PA
    No prior authorization on this plan for this class — document the clinical reason for the change.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Unitedhealthcare)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Humana)No PA
    Switch?Switch usually clears — no PA
    No prior authorization on this plan for this class — document the clinical reason for the change.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Humana)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Humana)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Cigna)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Cigna)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Cigna)No PA
    Switch?Switch usually clears — no PA
    No prior authorization on this plan for this class — document the clinical reason for the change.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Aetna)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Aetna)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Aetna)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Kaiser)No PA
    Switch?Switch usually clears — no PA
    No prior authorization on this plan for this class — document the clinical reason for the change.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Kaiser)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • glp1 agonists(Kaiser)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
commercial qhp
  • glp1 agonists(Molina Healthcare)PA required
    Switch?PA + step therapy — a prior in-class trial usually clears it
    This plan gates the class with PA + step therapy. A documented trial (or failure/intolerance) of an in-class agent — which your patient already has — typically satisfies the step requirement, so the switch clears.
    Brands
    ···
    Ozempic1952KMounjaro894Knew ’22Januvia828KTrulicity788KRybelsus310KVictoza104KSoliqua59KBydureon38KGlyxambi29KLiraglutide24Knew ’24Sitagliptin6Knew ’23Byetta3KExenatide0new ’24
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • insulins(Molina Healthcare)No PA
    Switch?PA + step therapy — a prior in-class trial usually clears it
    This plan gates the class with PA + quantity limit + step therapy. A documented trial (or failure/intolerance) of an in-class agent — which your patient already has — typically satisfies the step requirement, so the switch clears.
    Brands
    ···
    Lantus1687KInsulin1074KHumalog705KNovolog666KTresiba572KBasaglar424KInsulin Lispro408KToujeo324KHumulin311KLevemir262KNovolin177KInsulin Aspart168KFiasp160KAdmelog67KInsulin Degludec50KInsulin Glargine37KLyumjev31KApidra3K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • growth hormone(Molina Healthcare)PA required
    Switch?PA required — switch supported by prior therapy
    This plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.
    Brands
    ···
    Genotropin1KNorditropin779Omnitrope702Orilissa511Humatrope285Oriahnn49Ngenla0new ’23Skytrofa0new ’21Zomacton0
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
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.