Iowa Prior Authorization Requirements

Medicare TraditionalMedicare AdvantagePart DMedicaid MCODual-EligibleMedicaid FFSCommercial (employer / fully-insured)

PA required

64%

1,090 verified rules

Verified Jun 8, 2026

Service category PA

All programs combined

Specialty Drugs

5/6

Conditional

Durable Medical Equipment

5/6

Conditional

Skilled Nursing Facility

4/6

Conditional

Inpatient Hospital

4/6

Conditional

Outpatient Surgery

4/6

Conditional

Home Health

4/6

Conditional

Mental Health — Inpatient

4/6

Conditional

Ambulance Transport

3/6

Conditional

Occupational Therapy

3/6

Conditional

Substance Use Treatment

3/6

Conditional

Speech Therapy

3/6

Conditional

Physical Therapy

3/6

Conditional

Diagnostic Imaging

3/6

Conditional

advanced_imaging

3/6

Conditional

Laboratory

0/6

No PA

Drug class PA

Part D federal protections flagged

Oral Oncology

11/13

Conditional

ADHD Stimulants

10/12

Conditional

growth_hormone

8/8

Full PA

pulmonary_arterial_hypertension

8/8

Full PA

Immunosuppressants

7/9

Conditional

hereditary_angioedema

7/7

Full PA

glp1_agonists

7/7

Full PA

hepatitis_c_daa

7/7

Full PA

Rare Disease / Orphan

6/7

Conditional

migraine_cgrp

6/6

Full PA

anticonvulsants

6/8

Conditional

opioid_analgesics

6/7

Conditional

Brand (Generic Available)

5/6

Conditional

Controlled — Schedule II

5/6

Conditional

Antipsychotics

5/7

Conditional

Brand (No Generic)

5/6

Conditional

Hepatitis C

5/6

Conditional

Diabetes — Insulin

5/6

Conditional

Specialty Non-Biologic

5/6

Conditional

Diabetes — Non-Insulin

5/6

Conditional

Specialty Biologics

5/6

Conditional

asthma_copd_biologics

5/5

Full PA

Biosimilars

5/6

Conditional

Controlled — Schedule III–V

5/6

Conditional

testosterone_androgens

5/6

Conditional

antifungals_systemic

5/6

Conditional

pcsk9_inhibitors

5/6

Conditional

tnf_inhibitors

5/5

Full PA

il_inhibitors_biologics

5/5

Full PA

jak_inhibitors

5/5

Full PA

ms_disease_modifying

5/5

Full PA

atypical_antipsychotics

5/6

Conditional

Antidepressants

4/6

Conditional

other_antidepressants

4/6

Conditional

wakefulness_agents

4/4

Full PA

inhaled_respiratory

4/7

Conditional

antiplatelets

4/8

Conditional

HIV Antiretrovirals

3/13

Conditional

anxiolytics_benzodiazepines

3/7

Conditional

cystic_fibrosis_modulators

3/3

Full PA

ppi_acid_reducers

3/7

Conditional

skeletal_muscle_relaxants

3/7

Conditional

opioid_use_disorder

3/8

Conditional

oral_retinoids

3/7

Conditional

hemophilia_factors

3/3

Full PA

GLP-1 (Weight Loss)

2/6

Conditional

infertility_agents

2/2

Full PA

antibiotics_misc

2/2

Full PA

antihistamines

2/6

Conditional

hereditary_tyrosinemia

2/2

Full PA

anticoagulants_doac

2/7

Conditional

chelating_agents

2/2

Full PA

arbs

2/7

Conditional

diuretics

2/4

Conditional

insulins

2/7

Conditional

endometriosis_agents

2/2

Full PA

immunoglobulins

2/3

Conditional

nsaids

2/6

Conditional

oxybate_salts

2/2

Full PA

vasopressins

2/2

Full PA

overactive_bladder

2/6

Conditional

dalfampridine

2/2

Full PA

vmat2_inhibitors

2/2

Full PA

dermatology_biologics

2/2

Full PA

enzyme_replacement

2/2

Full PA

weight_loss_agents

2/2

Full PA

hematopoietic_growth_factors

2/2

Full PA

erectile_dysfunction

2/2

Full PA

glp1_diabetes

1/1

Full PA

respiratory_allergy_cough_cold

1/1

Full PA

leukotriene_modifiers

1/6

Conditional

bisphosphonates

1/6

Conditional

ace_thiazide_combos

1/1

Full PA

anti_infective_combos_misc

1/1

Full PA

ace_inhibitors

1/7

Conditional

antianginals

1/1

Full PA

ace_ccb_combos

1/1

Full PA

antianginals_isosorbide

1/1

Full PA

achondroplasia_treatments

1/1

Full PA

antiarrhythmics

1/3

Conditional

fabry_disease_agents

1/1

Full PA

antiasthmatic_5lipoxygenase

1/1

Full PA

gaucher_disease_agents

1/1

Full PA

pheochromocytoma_agents

1/1

Full PA

alcohol_deterrents

1/2

Conditional

allergenic_extracts

1/2

Conditional

alpha_proteinase_inhibitor

1/1

Full PA

als_drugs

1/1

Full PA

alzheimer_cholinomimetics

1/1

Full PA

aminoglycosides

1/1

Full PA

amyloidosis_treatments

1/1

Full PA

analgesics_misc

1/1

Full PA

anaphylaxis_therapy

1/1

Full PA

androgens_anabolics

1/1

Full PA

anorectal_misc

1/1

Full PA

anthelmintics

1/3

Conditional

antiasthmatic_anticholinergics

1/1

Full PA

antidotes_chelating

1/1

Full PA

antimycobacterials_antituberculosis

1/1

Full PA

beta_blockers

1/7

Conditional

diabetic_oral_sulfonylureas

1/1

Full PA

endothelin_angiotensin_ii_antagonists

1/1

Full PA

glucocorticoids_corticotropin

1/1

Full PA

antiasthmatic_antiinflammatory

1/1

Full PA

antiemetic_5ht3_substancep

1/1

Full PA

anti_parkinsonian_drugs

1/1

Full PA

beta_blockers_non_selective

1/1

Full PA

contraceptives_injectable

1/1

Full PA

other_antidiabetics

1/7

Conditional

erythropoiesis_stimulating_agents

1/1

Full PA

glucocorticoids_mineralocorticoids

1/1

Full PA

antiasthmatic_beta_adrenergics

1/1

Full PA

antiemetic_anticholinergic_dopaminergic

1/1

Full PA

beta_blocker_diuretic_combos

1/1

Full PA

contraceptives_monophasic

1/1

Full PA

diabetic_sulfonylurea_biguanide

1/1

Full PA

estrogen_combos

1/1

Full PA

gout_agents

1/2

Conditional

cannabinoid_antiemetics

1/3

Conditional

antipsychotics_typical

1/1

Full PA

beta_lactam_clavulanate_combos

1/1

Full PA

contraceptives_multiphasic

1/1

Full PA

diabetic_thiazolidinedione

1/1

Full PA

estrogens_patches

1/1

Full PA

granulocyte_csf

1/1

Full PA

antiasthmatic_misc_inhalants

1/1

Full PA

antispasmodics

1/1

Full PA

bph_agents

1/3

Conditional

contraceptives_patches_vaginal

1/1

Full PA

diabetic_thiazol_biguanide_combo

1/1

Full PA

estrogens_tabs

1/1

Full PA

antiasthmatic_mixed_adrenergics

1/1

Full PA

antispasmodics_long_acting

1/1

Full PA

calcium_channel_blockers

1/6

Conditional

contraceptives_progestin_only

1/1

Full PA

diabetic_amylin_analogs

1/1

Full PA

fluoroquinolones

1/2

Conditional

heart_failure_agents

1/1

Full PA

antiasthmatic_mucolytics

1/1

Full PA

anti_thrombocytopenics

1/1

Full PA

carbapenems

1/1

Full PA

contraceptives_triphasic

1/1

Full PA

dpp4_inhibitors

1/5

Conditional

gi_antiflatulents_stimulants

1/1

Full PA

hematopoietic_agents

1/1

Full PA

antiasthmatic_nasal_misc

1/1

Full PA

hemophilia_factor_viii

1/1

Full PA

antithyroid_therapies

1/1

Full PA

cardiac_glycosides

1/1

Full PA

cough_cold_antitussive_expectorant

1/1

Full PA

gi_antidiarrheal_antacid_misc

1/1

Full PA

hemostatic_agents

1/1

Full PA

antiasthmatic_steroid_inhalants

1/1

Full PA

carnitine_replenisher

1/1

Full PA

cough_cold_systemic_decongestants

1/1

Full PA

gi_antiperistaltic_agents

1/1

Full PA

hepatitis_b_only

1/1

Full PA

antiasthmatic_xanthines

1/1

Full PA

hemophilia_factor_x

1/1

Full PA

anxiolytics_long_acting

1/1

Full PA

ccb_lipid_combos

1/1

Full PA

covid19_agents

1/1

Full PA

diabetic_insulin_combinations

1/1

Full PA

gi_digestive_enzymes

1/1

Full PA

antihemophilic_agents

1/1

Full PA

anxiolytics_misc

1/1

Full PA

cns_agents_misc

1/1

Full PA

cox2_inhibitors_selective

1/1

Full PA

gi_h2_antagonists

1/1

Full PA

anti_cataplectic_agents

1/1

Full PA

arb_combinations

1/1

Full PA

cephalosporins

1/2

Conditional

cushings_disease_treatments

1/1

Full PA

sglt2_inhibitors

1/6

Conditional

gi_inflammatory_bowel_agents

1/1

Full PA

antihistamines_decongestant_combos

1/1

Full PA

arb_ccb_combos

1/1

Full PA

dpp1_inhibitors

1/1

Full PA

gi_irritable_bowel_syndrome_agents

1/1

Full PA

herpes_agents

1/1

Full PA

antihistamines_other

1/1

Full PA

arb_ccb_diuretics

1/1

Full PA

cytomegalovirus_agents

1/1

Full PA

direct_renin_inhibitors

1/2

Conditional

gi_misc

1/1

Full PA

hormone_receptor_modulators

1/1

Full PA

antidepressants_mao_inhibitors

1/1

Full PA

antihyperlipidemics

1/1

Full PA

cholesterol_bile_sequestrants

1/1

Full PA

dental_products

1/2

Conditional

gi_misc_anti_ulcer

1/1

Full PA

hyperparathyroid_vitamin_d_analogs

1/1

Full PA

ssri_antidepressants

1/5

Conditional

antihypertensives_central

1/1

Full PA

arb_diuretic_combos

1/1

Full PA

cholesterol_fibric_acid

1/1

Full PA

diabetic_alphaglucosidase

1/1

Full PA

dopamine_receptor_agonists

1/1

Full PA

gi_prostaglandins

1/1

Full PA

hyperparathyroid_vit_d_calcimimetics

1/1

Full PA

antidepressants_tricyclics

1/1

Full PA

anti_ige_anti_interleukin

1/1

Full PA

arthritis_misc

1/1

Full PA

statins

1/7

Conditional

ear_preparations

1/1

Full PA

idiopathic_pulmonary_fibrosis

1/1

Full PA

artificial_saliva_stimulants

1/1

Full PA

cholinergic

1/1

Full PA

insulin_penfills

1/1

Full PA

electrolytes_nutritionals

1/1

Full PA

ppi_nsaid_combo

1/1

Full PA

snri_antidepressants

1/2

Conditional

antileprotic

1/1

Full PA

atopic_dermatitis

1/1

Full PA

complement_inhibitors

1/1

Full PA

diabetic_meglitinides

1/1

Full PA

endocrine_metabolic_agents

1/1

Full PA

gi_ulcer_anti_infective

1/1

Full PA

antimalarial_agents

1/1

Full PA

beta_blockers_alpha_beta

1/1

Full PA

compounding_materials

1/1

Full PA

diabetic_oral_biguanides

1/1

Full PA

rifaximin_gi

1/1

Full PA

antidotes

1/1

Full PA

osteoporosis_anabolics

1/1

Full PA

pulmonary_fibrosis

1/1

Full PA

influenza_agents

1/1

Full PA

muscular_atrophy_agents

1/1

Full PA

op_carbonic_anhydrase_inhibitors

1/1

Full PA

powders

1/1

Full PA

interferon_gamma

1/1

Full PA

muscular_dystrophy_agents

1/1

Full PA

op_cycloplegics

1/1

Full PA

pressors

1/1

Full PA

stimulants_amphetamines_long_acting

1/1

Full PA

topical_enzymes_keratolytics_urea

1/1

Full PA

metabolic_bone_other

1/1

Full PA

k_removing_resins

1/1

Full PA

lincosamides_oxazolidinones_leprostatics

1/1

Full PA

op_misc

1/1

Full PA

progestins

1/2

Conditional

stimulants_methylphenidate

1/1

Full PA

topical_immunomodulators

1/1

Full PA

oncology_antiandrogens

1/1

Full PA

ophthalmic_anti_inflammatory_anti_infective

1/1

Full PA

lipodystrophy_agents

1/1

Full PA

narcotics_selected

1/1

Full PA

lithium

1/1

Full PA

opioid_long_acting

1/1

Full PA

op_prostaglandins

1/1

Full PA

macrolides_erythromycins_ketolides

1/1

Full PA

nasal_steroid_antihistamine_combos

1/1

Full PA

op_quinolones

1/1

Full PA

migraine_ergot_combinations

1/1

Full PA

ophthalmic_dry_eye_misc

1/1

Full PA

sedative_hypnotics

1/5

Conditional

migraine_ergotamine_derivatives

1/1

Full PA

triptans_injectable

1/1

Full PA

nicardipines

1/1

Full PA

triptans

1/8

Conditional

migraine_5ht_combinations

1/1

Full PA

nitro_ointment_cap_cream

1/1

Full PA

mineralocorticoid_receptor_antagonists

1/1

Full PA

minerals

1/1

Full PA

nitro_sublingual_spray

1/1

Full PA

parkinsons_anticholinergics

1/1

Full PA

mouth_anesthetics_topical

1/1

Full PA

mouth_steroids

1/1

Full PA

op_antiallergics_antihistamines

1/1

Full PA

parkinsons_dopamine_agonists

1/1

Full PA

sickle_cell_anemia_agents

1/1

Full PA

topical_antivirals

1/1

Full PA

mouth_anti_infectives

1/1

Full PA

op_antiallergics_mast_cell

1/1

Full PA

mouth_antiseptics

1/1

Full PA

sleep_and_wakefulness_agents

1/1

Full PA

op_beta_blockers

1/1

Full PA

platelet_aggr_inhibitors_combos_misc

1/1

Full PA

op_miotics_direct_acting

1/1

Full PA

nasal_steroids

1/1

Full PA

neurologics_misc

1/1

Full PA

op_rho_kinase_inhibitors

1/1

Full PA

pyruvate_kinase_activators

1/1

Full PA

tissue_plasminogen_activator

1/1

Full PA

nicotine_replacement_therapy

1/1

Full PA

opioid_withdrawal_treatments

1/1

Full PA

rheumatoid_arthritis_non_biologicals

1/1

Full PA

topical_antibiotic

1/1

Full PA

nitro_patches

1/1

Full PA

oxytocics

1/1

Full PA

sedative_hypnotics_benzodiazepines

1/1

Full PA

topical_antineoplastics

1/1

Full PA

parkinsons_comt_inhibitors

1/1

Full PA

op_antibiotics

1/1

Full PA

phosphodiesterase_inhibitors

1/1

Full PA

sle_agents

1/1

Full PA

op_antiinflammatory_steroids

1/1

Full PA

smoking_cessation_oral

1/1

Full PA

op_nsaids

1/1

Full PA

psychotherapeutic_combination

1/1

Full PA

stimulants_methylphenidate_long_acting

1/1

Full PA

op_quinolones_fourth_gen

1/1

Full PA

op_selective_alpha_adrenergic

1/1

Full PA

restless_leg_syndrome_agents

1/1

Full PA

osteoporosis

1/1

Full PA

sedative_hypnotics_barbiturate

1/1

Full PA

topical_antifungals

1/1

Full PA

phosphate_binders

1/2

Conditional

sinus_node_inhibitors

1/1

Full PA

topical_astringents_protectants

1/1

Full PA

progeria_treatments

1/1

Full PA

stimulants_amphetamines_short_acting

1/1

Full PA

pah_endothelin_receptor_antagonist

1/1

Full PA

tetracyclines

1/2

Conditional

purine_analog

1/1

Full PA

sedative_hypnotics_non_benzodiazepines

1/1

Full PA

sglt1_2_inhibitors

1/1

Full PA

somatostatic_agents

1/1

Full PA

topical_steroids

1/4

Conditional

thyroid_hormones

1/1

Full PA

topical_steroid_local_anesthetics

1/1

Full PA

topical_acne_preparations

1/1

Full PA

topical_antipruritics

1/1

Full PA

topical_antiseborrheics

1/1

Full PA

vaginal_estrogens

1/1

Full PA

topical_burn_products

1/1

Full PA

vitamins_misc

1/1

Full PA

oncology_topoisomerase_i_inhibitors

1/1

Full PA

topical_cauterizing_agents

1/1

Full PA

topical_emollients

1/1

Full PA

topical_genital_warts

1/1

Full PA

oncology_antiadrenals

1/1

Full PA

topical_local_anesthetics

1/1

Full PA

oncology_antiestrogens

1/1

Full PA

antiretrovirals_integrase_inhibitors

1/1

Full PA

topical_scabicides_pediculicides

1/1

Full PA

oncology_antimetabolites

1/1

Full PA

antiretrovirals_protease_inhibitors

1/1

Full PA

topical_steroid_combinations

1/1

Full PA

oncology_aromatase_inhibitors

1/1

Full PA

oncology_combinations

1/1

Full PA

topical_wound_decubitus_care

1/1

Full PA

urea_cycle_disorder_agents

1/1

Full PA

oncology_imidazotetrazines

1/1

Full PA

urological_misc

1/1

Full PA

oncology_misc

1/1

Full PA

vaginal_anti_fungals

1/1

Full PA

oncology_nitrogen_mustards

1/1

Full PA

vaginal_antibacterials

1/1

Full PA

vitamins

1/3

Conditional

oncology_selective_retinoid_x_receptor_agonists

1/1

Full PA

oncology_urinary_tract_protective_agents

1/1

Full PA

oncology_menin_inhibitors

1/1

Full PA

oncology_alkylating_agents

1/1

Full PA

antiretroviral_boosting_agent_cyp450

1/1

Full PA

oncology_androgen_biosynthesis_inhibitor

1/1

Full PA

oncology_cll_17p_deletion

1/1

Full PA

oncology_folic_acid_antagonist_rescue

1/1

Full PA

oncology_parp_inhibitors

1/1

Full PA

oncology_progestins

1/1

Full PA

oncology_protein_tyrosine_kinase_inhibitors

1/1

Full PA

antiretrovirals_capsid_inhibitors

1/1

Full PA

antiretrovirals_combinations

1/1

Full PA

antiretrovirals_entry_inhibitors

1/1

Full PA

antiretrovirals_nnrti

1/1

Full PA

antiretrovirals_nrti

1/1

Full PA

antiparasitics

1/1

Full PA

antivirals_other

1/2

Conditional

electrolytes_vitamins

1/1

Full PA

antibacterials_systemic

1/1

Full PA

dermatology_topical_and_biologics

1/1

Full PA

gi_bowel_motility

1/1

Full PA

thyroid_agents

1/3

Conditional

immunological_immunomodulators

1/1

Full PA

cns_miscellaneous

1/1

Full PA

sexual_dysfunction_agents

1/1

Full PA

cannabidiol

1/1

Full PA

allergen_immunotherapy

1/1

Full PA

il1_other_immunomodulators

1/1

Full PA

gnrh_oncology_hormonal

1/1

Full PA

transplant_immunosuppressants

1/1

Full PA

parkinsons_agents

1/1

Full PA

cough_cold

1/1

Full PA

continuous_glucose_monitors

1/1

Full PA

estrogens_hrt

1/1

Full PA

other_cardiovascular

1/1

Full PA

gi_other

1/1

Full PA

ophthalmic_agents

1/1

Full PA

miscellaneous_specialty

1/1

Full PA

other_lipid_agents

1/1

Full PA

antibiotics_general

1/1

Full PA

viscosupplements

1/1

Full PA

cortisol_synthesis_inhibitors

1/1

Full PA

oncology_supportive

1/1

Full PA

fertility_regulators

1/1

Full PA

acromegaly_agents

1/1

Full PA

calcium_regulators_misc

1/1

Full PA

uterine_fibroids

1/1

Full PA

als_agents

1/1

Full PA

myasthenia_gravis_agents

1/1

Full PA

narcolepsy_cataplexy_agents

1/1

Full PA

paroxysmal_nocturnal_hemoglobinuria

1/1

Full PA

immunomodulators

1/1

Full PA

movement_disorders

1/1

Full PA

growth_improvement_agents

1/1

Full PA

sickle_cell_disease

1/1

Full PA

immunologic_misc

1/1

Full PA

oncology_hormonal

1/2

Conditional

calcium_receptor_agonists

1/1

Full PA

polyneuropathy_agents

1/1

Full PA

bleeding_disorders_agents

1/1

Full PA

alpha1_antitrypsin_deficiency

1/1

Full PA

botulinum_toxins

1/1

Full PA

multiple_sclerosis_agents

1/1

Full PA

urea_cycle_disorder

1/1

Full PA

platelet_disorders

1/1

Full PA

central_precocious_puberty

1/1

Full PA

carnitine_deficiency_agents

1/1

Full PA

dermatology_antipsoriatics

1/1

Full PA

autoimmune_physician_administered

1/1

Full PA

ophthalmic_anti_vegf

1/1

Full PA

pulmonary_fibrosis_agents

1/1

Full PA

cough_cold_allergy

1/1

Full PA

hematopoietic_esa

1/1

Full PA

pde4_inhibitors_inflammatory

1/1

Full PA

antiparkinson_agents

1/1

Full PA

calcimimetics

1/1

Full PA

il_inhibitors_ibd

1/1

Full PA

dermatology_topical_other

1/1

Full PA

metabolic_disorder_agents

1/1

Full PA

hepatitis_b_agents

1/1

Full PA

immunosuppressants_misc

1/1

Full PA

neuro_psych_misc

1/1

Full PA

ovulation_stimulants

1/1

Full PA

ophthalmic_anti_inflammatory

1/1

Full PA

Compounded Medications

0/6

No PA

Opioid Treatment (MOUD)

0/6

No PA

anaphylaxis_epinephrine

0/1

No PA

vaccines

0/2

No PA

inflammatory_bowel_disease

0/2

No PA

roflumilast

0/2

No PA

antiasthmatic_adrenergic_combos

0/1

No PA

contraceptives_emergency

0/1

No PA

hemophilia_factor_ix

0/1

No PA

hemophilia_factor_vii

0/1

No PA

dpp4_inhibitor_combinations

0/1

No PA

hemophilia_factor_vwf

0/1

No PA

sglt2_inhibitor_combinations

0/1

No PA

immune_serums

0/1

No PA

otic_agents

0/4

No PA

bipolar_agents_lithium

0/1

No PA

antigout_agents

0/1

No PA

antidementia_alzheimers

0/1

No PA

antimyasthenic_agents

0/1

No PA

dental_oral_agents

0/1

No PA

oral_corticosteroids

0/1

No PA

antimycobacterials_tb

0/1

No PA

hepatitis_b_antivirals

0/1

No PA

nutritional_dietary

0/1

No PA

smoking_cessation

0/1

No PA

alzheimers_agents

0/2

No PA

contraceptives

0/3

No PA

feminine_products

0/1

No PA

antimalarials

0/2

No PA

antilipemics_bile_acid_resins

0/1

No PA

antitubercular_agents

0/1

No PA

non_opioid_analgesics

0/2

No PA

nitrates

0/1

No PA

mood_stabilizers

0/1

No PA

glucose_elevating_agents

0/1

No PA

h2_receptor_antagonists

0/1

No PA

benign_prostatic_hyperplasia

0/1

No PA

fibromyalgia_agents

0/1

No PA

musculoskeletal_therapy_agents

0/1

No PA

antibacterials_misc

0/1

No PA

laxatives

0/2

No PA

anti_infectives_misc

0/1

No PA

digitalis_glycosides

0/1

No PA

vaginal_anti_infectives

0/2

No PA

migraine_ergotamines

0/1

No PA

menopausal_symptom_agents

0/1

No PA

vitamin_d_analogs

0/1

No PA

gastrointestinal_misc

0/1

No PA

antidementia_agents

0/1

No PA

diabetic_supplies

0/1

No PA

endocrine_metabolic_misc

0/1

No PA

gi_anticholinergics

0/1

No PA

antilipemics_cholesterol_absorption

0/1

No PA

postherpetic_neuralgia

0/1

No PA

antidiarrheals

0/1

No PA

antivirals_systemic

0/1

No PA

cardiovascular_misc

0/1

No PA

smoking_deterrents

0/1

No PA

antilipemics_fibrates

0/1

No PA

antiparkinsonian_agents

0/1

No PA

psychotherapeutic_misc

0/1

No PA

rectal_corticosteroids

0/1

No PA

antilipemics_misc

0/1

No PA

cns_misc

0/1

No PA

glucocorticoids

0/1

No PA

gi_antispasmodics

0/1

No PA

ulcer_therapy_combinations

0/1

No PA

dmards

0/1

No PA

ophthalmic_antiallergics

0/1

No PA

salicylates

0/1

No PA

macrolides

0/1

No PA

ophthalmic_anti_infectives

0/1

No PA

genitourinary_misc

0/1

No PA

alpha_blockers

0/1

No PA

electrolytes

0/1

No PA

ophthalmic_carbonic_anhydrase_inhibitors

0/1

No PA

dermatology_acne

0/1

No PA

dermatology_misc

0/1

No PA

aldosterone_antagonists

0/1

No PA

ophthalmic_anti_inflammatories

0/1

No PA

anaphylaxis_treatment_agents

0/1

No PA

dermatology_local_anesthetics

0/1

No PA

ophthalmic_antiglaucoma_beta_blockers

0/1

No PA

ophthalmic_antiglaucoma_combinations

0/1

No PA

dermatology_antiseborrheics

0/1

No PA

dermatology_actinic_keratosis

0/1

No PA

cold_cough

0/1

No PA

dermatology_antifungals

0/1

No PA

dermatology_wound_care

0/1

No PA

nutritional_misc

0/1

No PA

dermatology_rosacea

0/1

No PA

prenatal_vitamins

0/1

No PA

ophthalmic_misc

0/1

No PA

dermatology_antibiotics

0/1

No PA

dermatology_scabicides_pediculicides

0/1

No PA

ophthalmic_prostaglandins

0/1

No PA

ophthalmic_rho_kinase_inhibitors

0/1

No PA

mast_cell_stabilizers

0/1

No PA

ophthalmic_sympathomimetics

0/1

No PA

respiratory_misc

0/1

No PA

ophthalmic_anti_infective_anti_inflammatory

0/1

No PA

ophthalmic_other

0/1

No PA

xanthines

0/1

No PA

dermatology_antipruritic

0/1

No PA

mouth_throat_dental_agents

0/1

No PA

antianginal_nitrates

0/1

No PA

antiemetics

0/1

No PA

other_antihyperlipidemics

0/1

No PA

antimyasthenic_cholinergic

0/1

No PA

cardiotonics

0/1

No PA

digestive_enzymes

0/1

No PA

estrogens_progestins

0/1

No PA

antimycobacterial

0/1

No PA

serms

0/1

No PA

hematinics_other

0/1

No PA

opioid_reversal_antidotes

0/1

No PA

corticosteroids_systemic

0/1

No PA

antipsoriatics_topical

0/1

No PA

anticoagulants_warfarin

0/1

No PA

arni_sacubitril

0/1

No PA

vasopressin_desmopressin

0/1

No PA

interstitial_cystitis

0/1

No PA

hemostatics

0/1

No PA

anticoagulants_heparins

0/1

No PA

antidiarrheal_probiotic

0/1

No PA

other_antihypertensives

0/1

No PA

ophthalmic_glaucoma

0/1

No PA

topical_anti_infectives

0/1

No PA

nutritional_metabolic

0/1

No PA

mouth_throat_dental

0/1

No PA

vaccines_toxoids

0/1

No PA

smoking_alcohol_deterrents

0/1

No PA

vasopressors_anaphylaxis

0/1

No PA

medical_supplies_devices

0/1

No PA

fibromyalgia_snri

0/1

No PA

vitamins_minerals

0/1

No PA

anorectal_rectal

0/1

No PA

pharmaceutical_adjuvants

0/1

No PA

PA type breakdown

clinical_criteria

569

Conditional

Full PA

Federal protected classes requiring PA

Oral OncologyPA required

AntipsychoticsPA required

AntidepressantsPA required

AntipsychoticsPA required

ImmunosuppressantsPA required

Oral OncologyPA required

ImmunosuppressantsPA required

AntidepressantsPA required

State flags

Medicaid expansion state

WISeR pilot (high data quality)

FFS-dominant (minimal MCO)

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