Auth57 · Specialty PA Pack
Psychiatry / Behavioral Health
For the psychiatrist prescribing stimulants, antipsychotics, and antidepressants — coverage and appeals, every plan.
Structured rules
3,219
PA-required
70%
Appeal layer
51/51
Criteria docs
48/51
The breadth · all 51 jurisdictions
Every state, quantified for psychiatry / behavioral health
| State | Rules | PA-required | Appeal | Criteria docs |
|---|---|---|---|---|
| AKAlaska | 44 | 68% | ✓ | 2 |
| ALAlabama | 65 | 72% | ✓ | 12 |
| ARArkansas | 74 | 73% | ✓ | 3 |
| AZArizona | 68 | 74% | ✓ | 9 |
| CACalifornia | 74 | 62% | ✓ | 18 |
| COColorado | 67 | 66% | ✓ | 3 |
| CTConnecticut | 66 | 71% | ✓ | 2 |
| DCDistrict of Columbia | 67 | 66% | ✓ | 11 |
| DEDelaware | 67 | 73% | ✓ | 3 |
| FLFlorida | 68 | 72% | ✓ | 4 |
| GAGeorgia | 74 | 64% | ✓ | 27 |
| HIHawaii | 68 | 63% | ✓ | 11 |
| IAIowa | 68 | 72% | ✓ | 7 |
| IDIdaho | 50 | 66% | ✓ | 4 |
| ILIllinois | 66 | 71% | ✓ | 4 |
| INIndiana | 64 | 72% | ✓ | 7 |
| KSKansas | 65 | 72% | ✓ | 15 |
| KYKentucky | 74 | 73% | ✓ | 5 |
| LALouisiana | 60 | 70% | ✓ | 10 |
| MAMassachusetts | 56 | 70% | ✓ | 17 |
| MDMaryland | 59 | 63% | ✓ | 12 |
| MEMaine | 61 | 70% | ✓ | 4 |
| MIMichigan | 62 | 63% | ✓ | 11 |
| MNMinnesota | 49 | 67% | ✓ | 1 |
| MOMissouri | 76 | 74% | ✓ | 8 |
| MSMississippi | 73 | 73% | ✓ | 12 |
| MTMontana | 47 | 66% | ✓ | 3 |
| NCNorth Carolina | 73 | 74% | ✓ | 33 |
| NDNorth Dakota | 47 | 68% | ✓ | 3 |
| NENebraska | 58 | 69% | ✓ | 2 |
| NHNew Hampshire | 61 | 72% | ✓ | — |
| NJNew Jersey | 60 | 67% | ✓ | 3 |
| NMNew Mexico | 51 | 65% | ✓ | 8 |
| NVNevada | 62 | 71% | ✓ | 33 |
| NYNew York | 68 | 72% | ✓ | 9 |
| OHOhio | 74 | 74% | ✓ | 23 |
| OKOklahoma | 74 | 74% | ✓ | — |
| OROregon | 71 | 68% | ✓ | 7 |
| PAPennsylvania | 62 | 71% | ✓ | 19 |
| RIRhode Island | 49 | 69% | ✓ | — |
| SCSouth Carolina | 67 | 72% | ✓ | 5 |
| SDSouth Dakota | 45 | 64% | ✓ | 2 |
| TNTennessee | 67 | 73% | ✓ | 7 |
| TXTexas | 74 | 73% | ✓ | 59 |
| UTUtah | 68 | 74% | ✓ | 15 |
| VAVirginia | 71 | 66% | ✓ | 17 |
| VTVermont | 42 | 62% | ✓ | 4 |
| WAWashington | 73 | 73% | ✓ | 9 |
| WIWisconsin | 67 | 73% | ✓ | 2 |
| WVWest Virginia | 55 | 71% | ✓ | 1 |
| WYWyoming | 48 | 65% | ✓ | 8 |
Free preview· Texas
What a fully-unlocked state looks like
medicare traditional
- adhd stimulantsNo PAADHD stimulants under Part D PDP. No FFS Part B PA.
medicaid ffs
- ssri antidepressantsPA requiredTX Medicaid PDL: non-preferred agents require PA (step therapy). Source: Acentra TX PDL Criteria Guide 2026-01-30 (official companion to TX Medicaid PDL).
- other antidepressantsPA requiredTX Medicaid PDL: non-preferred agents require PA (step therapy). Source: Acentra TX PDL Criteria Guide 2026-01-30 (official companion to TX Medicaid PDL).
- atypical antipsychoticsPA requiredTX Medicaid PDL: non-preferred agents require PA (step therapy). Source: Acentra TX PDL Criteria Guide 2026-01-30 (official companion to TX Medicaid PDL).
- anxiolytics benzodiazepinesPA requiredTX Medicaid PDL: non-preferred agents require PA (step therapy). Source: Acentra TX PDL Criteria Guide 2026-01-30 (official companion to TX Medicaid PDL).
- anticonvulsantsNo PATX Medicaid: ALL-PREFERRED / protected class — no PDL prior authorization. Source: Acentra TX PDL Criteria Guide 2026-01-30 (official companion to TX Medicaid PDL).
- adhd stimulants(FFS)PA requiredTX Medicaid PDL: non-preferred agents require PA (step therapy). Source: Acentra TX PDL Criteria Guide 2026-01-30 (official companion to TX Medicaid PDL).
medicaid mco
- adhd stimulantsPA requiredstep therapyprescriber attestation for children
dual eligible
- adhd stimulantsPA requiredPart D primary. PA for brand/non-preferred. LIS eliminates cost-sharing.
medicare advantage
- adhd stimulants(MA Part D)PA requiredBrand/non-preferred stimulants may require PA on MA Part D.
part d
- adhd stimulantsPA requiredBrand/non-preferred stimulants require PA on Part D.
- atypical antipsychotics(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- other antidepressants(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- anticonvulsants(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- ssri antidepressants(Centene)No PACentene Part D (CMS formulary file, plan-grounded).
- adhd stimulants(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- anxiolytics benzodiazepines(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
- other antidepressants(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- adhd stimulants(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- atypical antipsychotics(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- anxiolytics benzodiazepines(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- ssri antidepressants(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- anticonvulsants(Unitedhealthcare)PA requiredUnitedhealthcare Part D (CMS formulary file, plan-grounded).
- adhd stimulants(Humana)No PAHumana Part D (CMS formulary file, plan-grounded).
- anxiolytics benzodiazepines(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- ssri antidepressants(Humana)No PAHumana Part D (CMS formulary file, plan-grounded).
- other antidepressants(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- atypical antipsychotics(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- anticonvulsants(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
- adhd stimulants(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- anticonvulsants(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- ssri antidepressants(Cigna)No PACigna Part D (CMS formulary file, plan-grounded).
- other antidepressants(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- atypical antipsychotics(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- anxiolytics benzodiazepines(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
- other antidepressants(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- atypical antipsychotics(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- anxiolytics benzodiazepines(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- ssri antidepressants(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- adhd stimulants(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
- anticonvulsants(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
commercial regulated
- anticonvulsants(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Anticonvulsants-seizures; many brand agents carry PA (APTIOM, KEPPRA, TOPAMAX, VIMPAT, XCOPRI); EPIDIOLEX PA+SP [e.g. APTIOM, BRIVIACT, DEPAKOTE, KEPPRA]
- anxiolytics benzodiazepines(UnitedHealthcare)No PAUnitedHealthcare commercial (Advantage 3-Tier). Anxiolytics-anxiety; all tier 1, no PA/ST/QL [e.g. alprazolam, lorazepam, clonazepam, buspirone]
- atypical antipsychotics(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Antipsychotics-mood disorders; generics QL only but CAPLYTA carries PA+ST+QL; brands REXULTI/VRAYLAR QL [e.g. aripiprazole, risperidone, quetiapine, CAPLYTA]
- adhd stimulants(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). CNS-attention deficit; generics QL but AZSTARYS/JORNAY PM (ST,QL) and XELSTRYM (PA,QL) carry step/PA [e.g. amphetamine-dextroamphetamine, methylphenidate, lisdexamfetamine, AZSTARYS]
- ssri antidepressants(Cigna)No PACigna commercial (Advantage 3-Tier). SSRIs open, QL only [e.g. fluoxetine, sertraline, escitalopram, paroxetine]
- atypical antipsychotics(Cigna)PA requiredCigna commercial (Advantage 3-Tier). generic atypicals open (QL); SECUADO=ST [e.g. aripiprazole, risperidone, quetiapine, CAPLYTA]
- other antidepressants(Cigna)PA requiredCigna commercial (Advantage 3-Tier). mixed; AUVELITY=ST, ZURZUVAE/NUPLAZID=PA [e.g. AUVELITY, ZURZUVAE, NUPLAZID, bupropion]
- anxiolytics benzodiazepines(Cigna)No PACigna commercial (Advantage 3-Tier). benzodiazepines/buspirone open in anxiety section [e.g. alprazolam, lorazepam, buspirone]
- adhd stimulants(Cigna)PA requiredCigna commercial (Advantage 3-Tier). ADHD stimulants broadly carry PA (incl generics) [e.g. methylphenidate, lisdexamfetamine, dextroamphetamine-amphetamine, AZSTARYS]
- anticonvulsants(Cigna)PA requiredCigna commercial (Advantage 3-Tier). generic AEDs open; branded (BRIVIACT/DILANTIN/OXTELLAR/XCOPRI/SPRITAM/TEGRETOL XR)=PA [e.g. gabapentin, lamotrigine, levetiracetam, topiramate]
- other antidepressants(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. single ANTIDEPRESSANTS heading covers SSRI/SNRI/other; open generics, some brands ST [e.g. sertraline, escitalopram, fluoxetine, venlafaxine]
- atypical antipsychotics(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. oral generics open; LAI injectables specialty PA [e.g. aripiprazole, quetiapine, risperidone, ABILIFY MAINTENA]
- anticonvulsants(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. antiseizure agents, open generics; some brands ST [e.g. levetiracetam, lamotrigine, topiramate, gabapentin]
- anxiolytics benzodiazepines(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. benzodiazepines, QL but open generics [e.g. alprazolam, lorazepam, clonazepam, diazepam]
- adhd stimulants(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. stimulants carry QL/PA (age/quantity edits) [e.g. amphetamine salts, methylphenidate, lisdexamfetamine (VYVANSE)]
- adhd stimulants(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. All ADHD agents (amphetamines, mixtures, alpha-agonists, SNRI) carry PA [e.g. amphetamine-dextroamphetamine, lisdexamfetamine, dextroamphetamine, atomoxetine]
- anxiolytics benzodiazepines(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. Antianxiety + benzodiazepines: QL only, open [e.g. alprazolam, lorazepam, buspirone, diazepam]
- other antidepressants(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. Misc/serotonin modulators/TCA/MAOI/tetracyclic: QL only, open [e.g. bupropion, mirtazapine, nefazodone, amitriptyline]
- ssri antidepressants(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. SSRIs: no PA, open [e.g. citalopram, sertraline, fluoxetine, escitalopram]
- atypical antipsychotics(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. Antipsychotics/antimanic subclasses carry PA + QL [e.g. aripiprazole, olanzapine, quetiapine, risperidone]
- anticonvulsants(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. All anticonvulsant subclasses: QL only, no PA; open [e.g. levetiracetam, lamotrigine, carbamazepine er, divalproex]
commercial qhp
- other antidepressants(Marketplace QHP (aggregate))PA requiredACA marketplace QHP — aggregated across the state's exchange issuers (PA if any issuer gates the class). Source: CMS machine-readable formulary PUF.
- atypical antipsychotics(Marketplace QHP (aggregate))PA requiredACA marketplace QHP — aggregated across the state's exchange issuers (PA if any issuer gates the class). Source: CMS machine-readable formulary PUF.
- anticonvulsants(Marketplace QHP (aggregate))PA requiredACA marketplace QHP — aggregated across the state's exchange issuers (PA if any issuer gates the class). Source: CMS machine-readable formulary PUF.
- anxiolytics benzodiazepines(Marketplace QHP (aggregate))PA requiredACA marketplace QHP — aggregated across the state's exchange issuers (PA if any issuer gates the class). Source: CMS machine-readable formulary PUF.
- ssri antidepressants(Marketplace QHP (aggregate))PA requiredACA marketplace QHP — aggregated across the state's exchange issuers (PA if any issuer gates the class). Source: CMS machine-readable formulary PUF.
- adhd stimulants(Marketplace QHP (aggregate))PA requiredACA marketplace QHP — aggregated across the state's exchange issuers (PA if any issuer gates the class). Source: CMS machine-readable formulary PUF.
- ssri antidepressants(Molina Healthcare)No PAMolina Healthcare commercial formulary. SSRI section open, QL only
- atypical antipsychotics(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. paliperidone ER, aripiprazole ODT and others carry PA
- anxiolytics benzodiazepines(Molina Healthcare)No PAMolina Healthcare commercial formulary. Antianxiety-misc and benzodiazepine sections open
- other antidepressants(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. vilazodone and Trintellix (vortioxetine) carry PA; bupropion open
- adhd stimulants(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. Several amphetamines and stimulants-misc carry PA; alpha-agonist ER PA
- anticonvulsants(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. 2 PA flags across anticonvulsants block
If denied in Texas
📨 Program Support Unit (PSU)
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Full criteria, sources & appeal paths — all 51 states.
You’ve seen the breadth and one state in full. The complete Psychiatry / Behavioral Healthpack — every state’s criteria, source citations, and step-by-step appeal instructions — is one email away.
Assembled from Auth57’s rules + criteria corpus + 51-state appeal layer. Draft data — verify against the payer’s current policy before relying.