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Neurology care
Auth57 · Specialty PA Pack

Neurology

For the neurologist managing MS and migraine therapies — coverage, criteria, and appeals across all 51 states.

Unlock all 51 states →See a free state →
Structured rules
1,002
PA-required
99%
Appeal layer
51/51
Criteria docs
44/51
The breadth · all 51 jurisdictions

Every state, quantified for neurology

StateApproved · CY25RulesPA-requiredAppealCriteria docs
● Recent · CY2025 disclosures — click a state to drill in
WAWashington▸ viewing88.2%23100%✓6
COColorado91.8%2195%✓10
OHOhio77.7%23100%✓14
All states · A–Z
AKAlaska—13100%✓2
ALAlabama—21100%✓6
ARArkansas—23100%✓2
AZArizona—21100%✓6
CACalifornia—2396%✓7
CTConnecticut—21100%✓3
DCDistrict of Columbia—2195%✓9
DEDelaware—20100%✓3
FLFlorida—21100%✓—
GAGeorgia—2396%✓12
HIHawaii—2195%✓5
IAIowa—21100%✓6
IDIdaho—15100%✓1
ILIllinois—20100%✓—
INIndiana—21100%✓2
KSKansas—20100%✓11
KYKentucky—23100%✓3
LALouisiana—19100%✓9
MAMassachusetts—17100%✓1
MDMaryland—1995%✓9
MEMaine—19100%✓3
MIMichigan—19100%✓6
MNMinnesota—15100%✓2
MOMissouri—25100%✓1
MSMississippi—23100%✓8
MTMontana—15100%✓2
NCNorth Carolina—23100%✓6
NDNorth Dakota—15100%✓—
NENebraska—19100%✓3
NHNew Hampshire—19100%✓—
NJNew Jersey—19100%✓3
NMNew Mexico—15100%✓3
NVNevada—19100%✓16
NYNew York—21100%✓3
OKOklahoma—23100%✓—
OROregon—2295%✓3
PAPennsylvania—19100%✓8
RIRhode Island—15100%✓—
SCSouth Carolina—21100%✓7
SDSouth Dakota—13100%✓—
TNTennessee—21100%✓4
TXTexas—23100%✓39
UTUtah—21100%✓11
VAVirginia—2396%✓5
VTVermont—13100%✓6
WIWisconsin—21100%✓3
WVWest Virginia—16100%✓1
WYWyoming—15100%✓5
Deep dive· Washington

Washington — neurology, 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.
  • MS disease-modifying therapiesPA 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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migrainePA 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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
commercial regulated
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(UnitedHealthcare)PA required
    Switch?PA + step therapy — a prior in-class trial usually clears it
    This plan gates the class with PA + quantity limit + 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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(Aetna (CVS Caremark))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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(Anthem Blue Cross (Elevance))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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
part d
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • MS disease-modifying therapies(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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
commercial qhp
  • MS disease-modifying therapies(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
    ···
    Dimethyl Fumarate8KTeriflunomide8KKesimpta7KGlatiramer5KCopaxone5KGlatopa5KAvonex4KFingolimod3KOcrevus3KVumerity3KAubagio2KTecfidera2KRebif2KMavenclad1KZeposia1KAmpyra1KBetaseron1KMayzent849
    # = Part D patients (Medicare CY2023; infused agents read low). new = FDA-approved 2021+.
  • CGRP inhibitors · migraine(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
    ···
    Nurtec105KUbrelvy83KEmgality61KAimovig56KQulipta45Knew ’21Ajovy24KZavzpret3Knew ’23Vyepti2K
    # = 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.