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FFS-dominant

Idaho Prior Authorization Requirements

Medicare TraditionalMedicare AdvantageMedicaid FFSDual-EligiblePart DMedicaid MCOCommercial (employer / fully-insured)Commercial — Marketplace QHP

PA required

55%

897 verified rules

Verified Jun 8, 2026

Service category PA

All programs combined
Durable Medical Equipment
5/6Conditional
Specialty Drugs
5/6Conditional
Inpatient Hospital
4/6Conditional
Skilled Nursing Facility
4/6Conditional
Mental Health — Inpatient
4/6Conditional
Home Health
4/6Conditional
Outpatient Surgery
4/6Conditional
Ambulance Transport
3/6Conditional
Occupational Therapy
3/6Conditional
Speech Therapy
3/6Conditional
Substance Use Treatment
3/6Conditional
Physical Therapy
3/6Conditional
advanced_imaging
3/6Conditional
Diagnostic Imaging
3/6Conditional
Laboratory
0/6No PA

Drug class PA

Part D federal protections flagged
ADHD Stimulants
11/13Conditional
Oral Oncology
11/13Conditional
glp1_agonists
8/8Full PA
hepatitis_c_daa
8/8Full PA
migraine_cgrp
8/8Full PA
growth_hormone
8/8Full PA
tnf_inhibitors
8/8Full PA
hereditary_angioedema
8/8Full PA
pulmonary_arterial_hypertension
8/8Full PA
Immunosuppressants
7/9Conditional
antifungals_systemic
7/8Conditional
ms_disease_modifying
7/7Full PA
opioid_analgesics
7/8Conditional
asthma_copd_biologics
7/7Full PA
il_inhibitors_biologics
7/7Full PA
jak_inhibitors
7/7Full PA
testosterone_androgens
7/8Conditional
atypical_antipsychotics
7/8Conditional
Rare Disease / Orphan
6/7Conditional
pcsk9_inhibitors
6/8Conditional
Specialty Non-Biologic
5/6Conditional
Controlled — Schedule III–V
5/6Conditional
Brand (No Generic)
5/6Conditional
Biosimilars
5/6Conditional
Diabetes — Non-Insulin
5/6Conditional
Specialty Biologics
5/6Conditional
Diabetes — Insulin
5/6Conditional
Controlled — Schedule II
5/6Conditional
Brand (Generic Available)
5/6Conditional
Antipsychotics
5/7Conditional
Hepatitis C
5/6Conditional
anticonvulsants
5/7Conditional
inhaled_respiratory
5/8Conditional
other_antidepressants
5/7Conditional
cystic_fibrosis_modulators
5/5Full PA
ppi_acid_reducers
5/8Conditional
hemophilia_factors
5/5Full PA
wakefulness_agents
5/5Full PA
Antidepressants
4/6Conditional
sglt2_inhibitors
4/8Conditional
dpp4_inhibitors
4/8Conditional
antiplatelets
4/8Conditional
overactive_bladder
4/8Conditional
dermatology_biologics
4/4Full PA
immunoglobulins
4/4Full PA
vmat2_inhibitors
4/4Full PA
oxybate_salts
4/4Full PA
dalfampridine
4/4Full PA
oral_retinoids
4/7Conditional
HIV AntiretroviralsFed. Protected
3/13Conditional
insulins
3/8Conditional
anticoagulants_doac
3/8Conditional
statins
3/8Conditional
other_antidiabetics
3/8Conditional
opioid_use_disorder
3/8Conditional
weight_loss_agents
3/4Conditional
anxiolytics_benzodiazepines
3/8Conditional
enzyme_replacement
3/3Full PA
nsaids
3/7Conditional
cannabidiol
2/3Conditional
GLP-1 (Weight Loss)
2/6Conditional
roflumilast
2/4Conditional
skeletal_muscle_relaxants
2/6Conditional
sedative_hypnotics
2/7Conditional
antiparkinson_agents
2/2Full PA
erectile_dysfunction
2/2Full PA
hematopoietic_growth_factors
2/2Full PA
infertility_agents
2/2Full PA
oncology_supportive
2/2Full PA
glp1_diabetes
1/1Full PA
ssri_antidepressants
1/6Conditional
snri_antidepressants
1/4Conditional
rett_syndrome
1/1Full PA
rsv_prophylaxis
1/1Full PA
rifaximin_gi
1/1Full PA
cannabinoid_antiemetics
1/3Conditional
non24_sleep_wake
1/1Full PA
esketamine
1/2Conditional
methadone
1/2Conditional
topical_steroids
1/5Conditional
sexual_dysfunction_agents
1/1Full PA
thyroid_agents
1/3Conditional
osteoporosis_anabolics
1/1Full PA
triptans
1/7Conditional
antivirals_other
1/2Conditional
ophthalmic_anti_inflammatory_anti_infective
1/1Full PA
cardiovascular_agents
1/1Full PA
gi_bowel_motility
1/1Full PA
pulmonary_fibrosis
1/1Full PA
antiparasitics
1/1Full PA
ophthalmic_dry_eye_misc
1/1Full PA
respiratory_allergy_cough_cold
1/1Full PA
sleep_and_wakefulness_agents
1/1Full PA
cns_miscellaneous
1/1Full PA
bisphosphonates
1/7Conditional
antibacterials_systemic
1/1Full PA
electrolytes_vitamins
1/1Full PA
immunological_immunomodulators
1/1Full PA
metabolic_bone_other
1/1Full PA
other_lipid_agents
1/1Full PA
miscellaneous_specialty
1/1Full PA
ophthalmic_agents
1/1Full PA
gnrh_oncology_hormonal
1/1Full PA
cough_cold
1/1Full PA
diuretics
1/3Conditional
calcium_channel_blockers
1/6Conditional
antihistamines
1/6Conditional
antibiotics_general
1/1Full PA
parkinsons_agents
1/1Full PA
allergen_immunotherapy
1/1Full PA
other_cardiovascular
1/1Full PA
estrogens_hrt
1/1Full PA
gi_other
1/1Full PA
arbs
1/6Conditional
continuous_glucose_monitors
1/1Full PA
transplant_immunosuppressants
1/1Full PA
il1_other_immunomodulators
1/1Full PA
viscosupplements
1/1Full PA
oncology_hormonal
1/2Conditional
multiple_sclerosis_agents
1/1Full PA
chelating_agents
1/1Full PA
cortisol_synthesis_inhibitors
1/1Full PA
endometriosis_agents
1/1Full PA
als_agents
1/1Full PA
movement_disorders
1/1Full PA
myasthenia_gravis_agents
1/1Full PA
fertility_regulators
1/1Full PA
acromegaly_agents
1/1Full PA
central_precocious_puberty
1/1Full PA
narcolepsy_cataplexy_agents
1/1Full PA
calcium_receptor_agonists
1/1Full PA
growth_improvement_agents
1/1Full PA
botulinum_toxins
1/1Full PA
hereditary_tyrosinemia
1/1Full PA
carnitine_deficiency_agents
1/1Full PA
calcium_regulators_misc
1/1Full PA
polyneuropathy_agents
1/1Full PA
urea_cycle_disorder
1/1Full PA
uterine_fibroids
1/1Full PA
paroxysmal_nocturnal_hemoglobinuria
1/1Full PA
ophthalmic_anti_vegf
1/2Conditional
pulmonary_fibrosis_agents
1/1Full PA
vasopressins
1/1Full PA
dermatology_antipsoriatics
1/1Full PA
sickle_cell_disease
1/1Full PA
bleeding_disorders_agents
1/1Full PA
platelet_disorders
1/1Full PA
immunomodulators
1/1Full PA
alpha1_antitrypsin_deficiency
1/1Full PA
autoimmune_physician_administered
1/1Full PA
immunologic_misc
1/1Full PA
pde4_inhibitors_inflammatory
1/1Full PA
antibiotics_misc
1/1Full PA
hepatitis_b_agents
1/1Full PA
immunosuppressants_misc
1/1Full PA
dermatology_topical_other
1/1Full PA
metabolic_disorder_agents
1/1Full PA
ophthalmic_anti_inflammatory
1/1Full PA
calcimimetics
1/1Full PA
il_inhibitors_ibd
1/1Full PA
cough_cold_allergy
1/1Full PA
hematopoietic_esa
1/1Full PA
neuro_psych_misc
1/1Full PA
ovulation_stimulants
1/1Full PA
ssri_snri_other_antidepressants
1/1Full PA
dermatology_topical_and_biologics
1/1Full PA
diabetes_supplies_glucose_monitoring
1/1Full PA
hormone_replacement_contraceptives
1/1Full PA
ibs_constipation
1/1Full PA
opioid_partial_agonists
1/1Full PA
hepatitis_b
1/1Full PA
antilipemics_acl_inhibitors
1/1Full PA
migraine_misc
1/1Full PA
ibs_diarrhea
1/1Full PA
pancreatic_enzymes
1/1Full PA
dry_eye_disease
1/1Full PA
dermatology_atopic_dermatitis
1/1Full PA
nasal_agents
1/1Full PA
Opioid Treatment (MOUD)
0/6No PA
Compounded Medications
0/6No PA
anaphylaxis_epinephrine
0/1No PA
dental_oral_agents
0/1No PA
oral_corticosteroids
0/1No PA
leukotriene_modifiers
0/6No PA
antimyasthenic_agents
0/1No PA
antidementia_alzheimers
0/1No PA
bph_agents
0/2No PA
inflammatory_bowel_disease
0/2No PA
antigout_agents
0/1No PA
antimycobacterials_tb
0/1No PA
bipolar_agents_lithium
0/1No PA
vaccines
0/2No PA
otic_agents
0/4No PA
hepatitis_b_antivirals
0/1No PA
contraceptives
0/3No PA
feminine_products
0/1No PA
ace_inhibitors
0/6No PA
dental_products
0/1No PA
vitamins
0/2No PA
alzheimers_agents
0/2No PA
beta_blockers
0/6No PA
nutritional_dietary
0/1No PA
smoking_cessation
0/1No PA
gout_agents
0/2No PA
antilipemics_cholesterol_absorption
0/1No PA
antivirals_systemic
0/1No PA
anti_infectives_misc
0/1No PA
aldosterone_antagonists
0/1No PA
antibacterials_misc
0/1No PA
antilipemics_bile_acid_resins
0/1No PA
salicylates
0/1No PA
cephalosporins
0/1No PA
alpha_blockers
0/1No PA
fluoroquinolones
0/1No PA
non_opioid_analgesics
0/2No PA
cardiovascular_misc
0/1No PA
digitalis_glycosides
0/1No PA
tetracyclines
0/1No PA
antilipemics_misc
0/1No PA
direct_renin_inhibitors
0/1No PA
antidementia_agents
0/1No PA
antitubercular_agents
0/1No PA
antilipemics_fibrates
0/1No PA
antimalarials
0/2No PA
postherpetic_neuralgia
0/1No PA
macrolides
0/1No PA
antiarrhythmics
0/2No PA
anthelmintics
0/2No PA
alcohol_deterrents
0/1No PA
endocrine_metabolic_misc
0/1No PA
psychotherapeutic_misc
0/1No PA
migraine_ergotamines
0/1No PA
nitrates
0/1No PA
mood_stabilizers
0/1No PA
antiparkinsonian_agents
0/1No PA
smoking_deterrents
0/1No PA
musculoskeletal_therapy_agents
0/1No PA
menopausal_symptom_agents
0/1No PA
glucocorticoids
0/1No PA
cns_misc
0/1No PA
fibromyalgia_agents
0/1No PA
diabetic_supplies
0/1No PA
glucose_elevating_agents
0/1No PA
phosphate_binders
0/1No PA
potassium_removing_agents
0/1No PA
progestins
0/1No PA
h2_receptor_antagonists
0/1No PA
dermatology_antipruritic
0/1No PA
dmards
0/1No PA
nutritional_misc
0/1No PA
ophthalmic_anti_infectives
0/1No PA
dermatology_rosacea
0/1No PA
vaginal_anti_infectives
0/2No PA
ophthalmic_anti_inflammatories
0/1No PA
ophthalmic_rho_kinase_inhibitors
0/1No PA
rectal_corticosteroids
0/1No PA
prenatal_vitamins
0/1No PA
cold_cough
0/1No PA
dermatology_scabicides_pediculicides
0/1No PA
vitamin_d_analogs
0/1No PA
dermatology_wound_care
0/1No PA
ophthalmic_sympathomimetics
0/1No PA
xanthines
0/1No PA
dermatology_antiseborrheics
0/1No PA
ulcer_therapy_combinations
0/1No PA
gi_anticholinergics
0/1No PA
ophthalmic_carbonic_anhydrase_inhibitors
0/1No PA
ophthalmic_other
0/1No PA
dermatology_acne
0/1No PA
mouth_throat_dental_agents
0/1No PA
benign_prostatic_hyperplasia
0/1No PA
ophthalmic_antiallergics
0/1No PA
laxatives
0/2No PA
allergenic_extracts
0/1No PA
dermatology_actinic_keratosis
0/1No PA
antidiarrheals
0/1No PA
ophthalmic_antiglaucoma_beta_blockers
0/1No PA
dermatology_antibiotics
0/1No PA
dermatology_local_anesthetics
0/1No PA
gastrointestinal_misc
0/1No PA
ophthalmic_misc
0/1No PA
ophthalmic_antiglaucoma_combinations
0/1No PA
mast_cell_stabilizers
0/1No PA
gi_antispasmodics
0/1No PA
genitourinary_misc
0/1No PA
anaphylaxis_treatment_agents
0/1No PA
electrolytes
0/1No PA
respiratory_misc
0/1No PA
dermatology_misc
0/1No PA
ophthalmic_anti_infective_anti_inflammatory
0/1No PA
ophthalmic_prostaglandins
0/1No PA
dermatology_antifungals
0/1No PA
antianginal_nitrates
0/1No PA
anticoagulants_heparins
0/1No PA
antidiarrheal_probiotic
0/1No PA
other_antihypertensives
0/1No PA
antimycobacterial
0/1No PA
serms
0/1No PA
hematinics_other
0/1No PA
ophthalmic_glaucoma
0/2No PA
anticoagulants_warfarin
0/1No PA
arni_sacubitril
0/1No PA
vasopressin_desmopressin
0/1No PA
interstitial_cystitis
0/1No PA
hemostatics
0/1No PA
opioid_reversal_antidotes
0/1No PA
corticosteroids_systemic
0/1No PA
antipsoriatics_topical
0/1No PA
fibromyalgia_snri
0/1No PA
vitamins_minerals
0/1No PA
antiemetics
0/1No PA
other_antihyperlipidemics
0/1No PA
antimyasthenic_cholinergic
0/1No PA
cardiotonics
0/1No PA
digestive_enzymes
0/1No PA
estrogens_progestins
0/1No PA
smoking_alcohol_deterrents
0/1No PA
vasopressors_anaphylaxis
0/1No PA
medical_supplies_devices
0/1No PA
topical_anti_infectives
0/1No PA
nutritional_metabolic
0/1No PA
mouth_throat_dental
0/1No PA
vaccines_toxoids
0/1No PA
anorectal_rectal
0/1No PA
pharmaceutical_adjuvants
0/1No PA
antilipemics_omega3
0/1No PA
heart_failure_agents
0/1No PA
gi_motility_ibs
0/1No PA
migraine_other
0/1No PA

PA type breakdown

clinical_criteria
366
Conditional
81
Full PA
49
step_therapy
1

Federal protected classes requiring PA

AntidepressantsPA required
AntipsychoticsPA required
ImmunosuppressantsPA required
Oral OncologyPA required
AntipsychoticsPA required
AntidepressantsPA required
ImmunosuppressantsPA required
Oral OncologyPA required

State flags

Medicaid expansion state
WISeR pilot (high data quality)
FFS-dominant (minimal MCO)

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