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Urology care
Auth57 · Specialty PA Pack

Urology

For the urologist on overactive-bladder and testosterone therapy — the PA and appeal map for every payer.

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Structured rules
1,044
PA-required
66%
Appeal layer
51/51
Criteria docs
46/51
The breadth · all 51 jurisdictions

Every state, quantified for urology

StateRulesPA-requiredAppealCriteria docs
AKAlaska1486%✓1
ALAlabama2167%✓2
ARArkansas2467%✓2
AZArizona2268%✓2
CACalifornia2454%✓4
COColorado2259%✓3
CTConnecticut2268%✓2
DCDistrict of Columbia2157%✓6
DEDelaware2268%✓3
FLFlorida2264%✓1
GAGeorgia2458%✓4
HIHawaii2259%✓1
IAIowa2268%✓5
IDIdaho1669%✓1
ILIllinois2065%✓3
INIndiana2167%✓1
KSKansas2268%✓3
KYKentucky2463%✓4
LALouisiana2075%✓8
MAMassachusetts1867%✓5
MDMaryland2060%✓5
MEMaine2065%✓2
MIMichigan2070%✓8
MNMinnesota1675%✓2
MOMissouri2463%✓—
MSMississippi2467%✓1
MTMontana1580%✓2
NCNorth Carolina2467%✓1
NDNorth Dakota1567%✓—
NENebraska2070%✓2
NHNew Hampshire2070%✓1
NJNew Jersey2065%✓2
NMNew Mexico1663%✓—
NVNevada2065%✓2
NYNew York2264%✓8
OHOhio2467%✓5
OKOklahoma2467%✓1
OROregon2463%✓3
PAPennsylvania2065%✓10
RIRhode Island1669%✓—
SCSouth Carolina2273%✓2
SDSouth Dakota1464%✓1
TNTennessee2167%✓4
TXTexas2467%✓18
UTUtah2268%✓5
VAVirginia2357%✓6
VTVermont1377%✓—
WAWashington2458%✓3
WIWisconsin2167%✓2
WVWest Virginia1776%✓1
WYWyoming1681%✓4
Free preview· Texas

What a fully-unlocked state looks like

medicaid ffs
  • overactive bladderPA 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).
  • testosterone androgensPA 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).
commercial regulated
  • overactive bladder(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Genitourinary-bladder/genital/kidney; OAB generics open, but mirabegron/ELMIRON/VELPHORO carry ST and VANRAFIA carries PA+QL+SP, TEZRULY PA [e.g. oxybutynin, solifenacin, mirabegron, tolterodine]
  • testosterone androgens(UnitedHealthcare)PA requiredUnitedHealthcare commercial (Advantage 3-Tier). Hormonal-testosterone replacement; topical gels and brands (KYZATREX, TESTIM) carry PA+QL; injectables open [e.g. testosterone gel, testosterone cypionate, KYZATREX, TESTIM]
  • testosterone androgens(Cigna)PA requiredCigna commercial (Advantage 3-Tier). androgens carry PA+QL (DEPO-TESTOSTERONE open) [e.g. testosterone gel, XYOSTED, DEPO-TESTOSTERONE, testosterone cypionate]
  • overactive bladder(Cigna)PA requiredCigna commercial (Advantage 3-Tier). urinary tract; OAB generics open (QL), VANRAFIA SP+PA [e.g. oxybutynin er, mirabegron er, solifenacin, tolterodine er]
  • overactive bladder(Aetna (CVS Caremark))No PAAetna (CVS Caremark) commercial formulary. urinary antispasmodics, open generics; brands ST [e.g. oxybutynin, tolterodine, mirabegron (MYRBETRIQ), solifenacin]
  • testosterone androgens(Aetna (CVS Caremark))PA requiredAetna (CVS Caremark) commercial formulary. androgens, PA/ST (lab + diagnosis edits) [e.g. testosterone cypionate, testosterone gel, ANDRODERM]
  • testosterone androgens(Anthem Blue Cross (Elevance))PA requiredAnthem Blue Cross (Elevance) commercial formulary. Androgens for men carry PA [e.g. danazol, testosterone (androgens)]
  • overactive bladder(Anthem Blue Cross (Elevance))No PAAnthem Blue Cross (Elevance) commercial formulary. Urinary antispasmodics (antimuscarinics): QL only, NO PA; open [e.g. oxybutynin, tolterodine, trospium, solifenacin]
part d
  • testosterone androgens(Centene)PA requiredCentene Part D (CMS formulary file, plan-grounded).
  • overactive bladder(Centene)No PACentene Part D (CMS formulary file, plan-grounded).
  • testosterone androgens(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
  • overactive bladder(Unitedhealthcare)No PAUnitedhealthcare Part D (CMS formulary file, plan-grounded).
  • testosterone androgens(Humana)PA requiredHumana Part D (CMS formulary file, plan-grounded).
  • overactive bladder(Humana)No PAHumana Part D (CMS formulary file, plan-grounded).
  • overactive bladder(Cigna)No PACigna Part D (CMS formulary file, plan-grounded).
  • testosterone androgens(Cigna)PA requiredCigna Part D (CMS formulary file, plan-grounded).
  • testosterone androgens(Aetna)PA requiredAetna Part D (CMS formulary file, plan-grounded).
  • overactive bladder(Aetna)No PAAetna Part D (CMS formulary file, plan-grounded).
commercial qhp
  • overactive bladder(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.
  • testosterone androgens(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.
  • testosterone androgens(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. methyltestosterone PA+age; testosterone esters QL only
  • overactive bladder(Molina Healthcare)PA requiredMolina Healthcare commercial formulary. Urinary antispasmodics carry 7 ST + 2 PA
If denied in Texas
📨 Program Support Unit (PSU)
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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.