Prior-authorization rules drift across every state, every program, every drug class — faster than any internal team can track. Auth57 is the source-linked, human-verified data layer that health plans, developers, and AI agents build on.
Every US health plan — Medicaid, Medicare Advantage, federal exchange QHP — has to comply with two federal rules that redefine how prior authorization works. Auth57 is the verified data layer that makes compliance possible.Here's what each rule actually says, in plain language.
Health plans must stand up FHIR-based PA APIs covering all 14 service categories. Standard PA decisions must return within 7 days, expedited within 72 hours. Denial reasons must be structured and API-retrievable. Annual metric reporting required.
Extends CMS-0057-F electronic PA to 20 drug classes under the medical benefit — immunomodulators, oncology injectables, specialty infusions, biosimilars, GLP-1s. Adds patient-hardship and continuity-of-therapy exception pathways.
Every rule in the dataset is human-reviewed against a named primary source — state Medicaid provider manual, CMS memorandum, payer preferred-drug list. The Watch pipeline runs daily, catches rule changes within 24 hours, and re-verifies before publishing.
That's why every response includes a source_url and last_verifieddate. You're not inheriting anyone's guess. You're inheriting the citation trail.
All three demos are public — no signup. Your team can poke at the same data we sell, on real state Medicaid + Medicare programs.
Grab an API key and you're 30 seconds from a working lookup. Or book 15 minutes for a 30-day demo key tuned to your use case.