Prior-authorization rules diverge state by state, and your cross-state spreadsheet can't keep up — divergence stays invisible until the next audit surfaces it. Compare shows exactly where PA policy splits, so you can standardize, spot outliers, and brief leadership in minutes.
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Two CMS mandates force multi-state plans to prove their prior authorization policy holds up everywhere. Compare surfaces the divergence before the audit does.
FHIR-based PA APIs across 14 service categories. Applies to Medicaid, CHIP, Medicare Advantage, and federal-exchange QHPs — every plan in your book of business.
Extends electronic prior authorization to 20 drug classes under the medical benefit — immunomodulators, oncology injectables, specialty infusions, biosimilars.
Run a query across up to 10 states. Compare groups them by actual policy, shows the rule behind each group, and calls out the states that break the pattern.
| State | Rule detail | Source confidence |
|---|---|---|
| PA required · 3 states | ||
| California | Full clinical review · BMI ≥ 30 | High |
| New Jersey | Step therapy after lifestyle program | High |
| Texas | Full clinical review · BMI ≥ 30 | High |
| No PA required · 3 states | ||
| Ohio | Covered at formulary tier 2 | Medium |
| Washington | Covered without PA | High |
| Arizona | Covered without PA | High |
Policy is split 3 / 3 across these states — no clear majority.
Compare clusters states by actual policy — not alphabet, not region. Where most of your book aligns, you see one rule. Where two or three states carve out an exception, they snap out of the cluster and announce themselves.
Know instantly where your PA policies diverge from CMS requirements across every state you operate in.
Brief leadership on multi-state PA policy with one export. No more spreadsheets compiled from 10 different sources.
Model the impact of national formulary decisions before rolling them out. See exactly which states will create friction.
Every rule is monitored, verified, and updated by our team before it reaches you. We read the sources — CMS bulletins, state Medicaid agency notices, payer policy updates — so your team never has to call to confirm.
Rule update
LiveTX · Medicaid MCO — GLP-1 step therapy
Step therapy requirement updated. Prior treatment failure documentation now required. Effective April 1, 2026.
Reviewed by Auth57 team · Source: HHSC Medicaid bulletin
Pending review
VerifyingCA Medi-Cal — biosimilars PA exemption
Proposed exemption for FDA-approved biosimilars under review. Not yet in effect — team monitoring.
Auth57 team review in progress · Source: DHCS bulletin draft
Confirmed unchanged
VerifiedNJ FamilyCare — oncology oral PA requirements
Quarterly verification complete. No changes to PA requirements for oral oncology agents.
Verified April 2026 · Source: NJDOH policy manual
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