Auth57 · Specialty PA Pack
Neurology
For the neurologist managing MS and migraine therapies — coverage, criteria, and appeals across all 51 states.
Structured rules
1,002
PA-required
99%
Appeal layer
51/51
Criteria docs
44/51
The breadth · all 51 jurisdictions
Every state, quantified for neurology
| State | Approved · CY25 | Rules | PA-required | Appeal | Criteria docs |
|---|---|---|---|---|---|
| ● Recent · CY2025 disclosures — click a state to drill in | |||||
| WAWashington▸ viewing | 88.2% | 23 | 100% | ✓ | 6 |
| COColorado | 91.8% | 21 | 95% | ✓ | 10 |
| OHOhio | 77.7% | 23 | 100% | ✓ | 14 |
| All states · A–Z | |||||
| AKAlaska | — | 13 | 100% | ✓ | 2 |
| ALAlabama | — | 21 | 100% | ✓ | 6 |
| ARArkansas | — | 23 | 100% | ✓ | 2 |
| AZArizona | — | 21 | 100% | ✓ | 6 |
| CACalifornia | — | 23 | 96% | ✓ | 7 |
| CTConnecticut | — | 21 | 100% | ✓ | 3 |
| DCDistrict of Columbia | — | 21 | 95% | ✓ | 9 |
| DEDelaware | — | 20 | 100% | ✓ | 3 |
| FLFlorida | — | 21 | 100% | ✓ | — |
| GAGeorgia | — | 23 | 96% | ✓ | 12 |
| HIHawaii | — | 21 | 95% | ✓ | 5 |
| IAIowa | — | 21 | 100% | ✓ | 6 |
| IDIdaho | — | 15 | 100% | ✓ | 1 |
| ILIllinois | — | 20 | 100% | ✓ | — |
| INIndiana | — | 21 | 100% | ✓ | 2 |
| KSKansas | — | 20 | 100% | ✓ | 11 |
| KYKentucky | — | 23 | 100% | ✓ | 3 |
| LALouisiana | — | 19 | 100% | ✓ | 9 |
| MAMassachusetts | — | 17 | 100% | ✓ | 1 |
| MDMaryland | — | 19 | 95% | ✓ | 9 |
| MEMaine | — | 19 | 100% | ✓ | 3 |
| MIMichigan | — | 19 | 100% | ✓ | 6 |
| MNMinnesota | — | 15 | 100% | ✓ | 2 |
| MOMissouri | — | 25 | 100% | ✓ | 1 |
| MSMississippi | — | 23 | 100% | ✓ | 8 |
| MTMontana | — | 15 | 100% | ✓ | 2 |
| NCNorth Carolina | — | 23 | 100% | ✓ | 6 |
| NDNorth Dakota | — | 15 | 100% | ✓ | — |
| NENebraska | — | 19 | 100% | ✓ | 3 |
| NHNew Hampshire | — | 19 | 100% | ✓ | — |
| NJNew Jersey | — | 19 | 100% | ✓ | 3 |
| NMNew Mexico | — | 15 | 100% | ✓ | 3 |
| NVNevada | — | 19 | 100% | ✓ | 16 |
| NYNew York | — | 21 | 100% | ✓ | 3 |
| OKOklahoma | — | 23 | 100% | ✓ | — |
| OROregon | — | 22 | 95% | ✓ | 3 |
| PAPennsylvania | — | 19 | 100% | ✓ | 8 |
| RIRhode Island | — | 15 | 100% | ✓ | — |
| SCSouth Carolina | — | 21 | 100% | ✓ | 7 |
| SDSouth Dakota | — | 13 | 100% | ✓ | — |
| TNTennessee | — | 21 | 100% | ✓ | 4 |
| TXTexas | — | 23 | 100% | ✓ | 39 |
| UTUtah | — | 21 | 100% | ✓ | 11 |
| VAVirginia | — | 23 | 96% | ✓ | 5 |
| VTVermont | — | 13 | 100% | ✓ | 6 |
| WIWisconsin | — | 21 | 100% | ✓ | 3 |
| WVWest Virginia | — | 16 | 100% | ✓ | 1 |
| WYWyoming | — | 15 | 100% | ✓ | 5 |
Deep dive· Washington
Washington — neurology, every program
Click any state in the table above to drill into its rules, approval rates, and appeal path.
● Rules verified as-of Jun 8, 2026Medicaid FFS · CY25
54.8%approved
Draft · aggregatedSource ↗⚠ Dental = ~78% of HCA fee-for-service PA volume and is dental-skewed; expedited EPAs aren't captured. Not representative of drug/medical PA. CY2025 data is preliminary.
medicaid ffs
Approved · CMS-0057-F 202554.8%
Draft · aggregatedSource ↗⚠ Dental = ~78% of HCA fee-for-service PA volume and is dental-skewed; expedited EPAs aren't captured. Not representative of drug/medical PA. CY2025 data is preliminary.
- MS disease-modifying therapiesPA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K ✓ — — — Copaxone 5K ✓ — — — Avonex 4K ✓ — — — Ocrevus 3K ✓ — — — Vumerity 3K ✓ — — — Aubagio 2K ✓ — — — Tecfidera 2K ✓ — — — Rebif 2K ✓ — — — Mavenclad 1K ✓ — — — Zeposia 1K ✓ — — — Betaseron 1K ✓ — — — Mayzent 849 ✓ — — — Gilenya 839 ✓ — — — Tysabri 566 ✓ — — — Plegridy 509 ✓ — — — Briumvi 155 ✓ — — — Ponvory 79 ✓ — — — Lemtrada 0 ✓ — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy. - CGRP inhibitors · migrainePA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K ✓ — — — Ubrelvy 83K ✓ — — — Emgality 61K ✓ — — — Aimovig 56K ✓ — — — Qulipta 45K ✓ — — — Ajovy 24K ✓ — — — Zavzpret 3K ✓ — — — Vyepti 2K ✓ — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy.
commercial regulated
- CGRP inhibitors · migraine(UnitedHealthcare)PA requiredSwitching a patient to this agent?PA + step therapy — a prior in-class trial usually clears itThis plan gates the class with PA + quantity limit + step therapy. A documented trial (or failure/intolerance) of an in-class agent — which your patient already has — typically satisfies the step requirement, so the switch clears.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K ✓ ✓ ✓ — Ubrelvy 83K ✓ ✓ ✓ — Emgality 61K ✓ ✓ ✓ — Aimovig 56K ✓ ✓ ✓ — Qulipta 45K ✓ ✓ ✓ — Ajovy 24K ✓ ✓ ✓ — Zavzpret 3K ✓ ✓ ✓ — Vyepti 2K ✓ ✓ ✓ — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy. - MS disease-modifying therapies(UnitedHealthcare)PA requiredSwitching a patient to this agent?PA + step therapy — a prior in-class trial usually clears itThis plan gates the class with PA + quantity limit + specialty pharmacy + step therapy. A documented trial (or failure/intolerance) of an in-class agent — which your patient already has — typically satisfies the step requirement, so the switch clears.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K ✓ ✓ ✓ — Copaxone 5K ✓ ✓ ✓ — Avonex 4K ✓ ✓ ✓ — Ocrevus 3K ✓ ✓ ✓ — Vumerity 3K ✓ ✓ ✓ — Aubagio 2K ✓ ✓ ✓ — Tecfidera 2K ✓ ✓ ✓ — Rebif 2K ✓ ✓ ✓ — Mavenclad 1K ✓ ✓ ✓ — Zeposia 1K ✓ ✓ ✓ — Betaseron 1K ✓ ✓ ✓ — Mayzent 849 ✓ ✓ ✓ — Gilenya 839 ✓ ✓ ✓ — Tysabri 566 ✓ ✓ ✓ — Plegridy 509 ✓ ✓ ✓ — Briumvi 155 ✓ ✓ ✓ — Ponvory 79 ✓ ✓ ✓ — Lemtrada 0 ✓ ✓ ✓ — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy. - CGRP inhibitors · migraine(Cigna)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K ✓ — — — Ubrelvy 83K ✓ — — — Emgality 61K ✓ — — — Aimovig 56K ✓ — — — Qulipta 45K ✓ — — — Ajovy 24K ✓ — — — Zavzpret 3K ✓ — — — Vyepti 2K ✓ — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy. - MS disease-modifying therapies(Cigna)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA + specialty pharmacy. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K ✓ — ✓ — Copaxone 5K ✓ — ✓ — Avonex 4K ✓ — ✓ — Ocrevus 3K ✓ — ✓ — Vumerity 3K ✓ — ✓ — Aubagio 2K ✓ — ✓ — Tecfidera 2K ✓ — ✓ — Rebif 2K ✓ — ✓ — Mavenclad 1K ✓ — ✓ — Zeposia 1K ✓ — ✓ — Betaseron 1K ✓ — ✓ — Mayzent 849 ✓ — ✓ — Gilenya 839 ✓ — ✓ — Tysabri 566 ✓ — ✓ — Plegridy 509 ✓ — ✓ — Briumvi 155 ✓ — ✓ — Ponvory 79 ✓ — ✓ — Lemtrada 0 ✓ — ✓ — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy. - CGRP inhibitors · migraine(Aetna (CVS Caremark))PA requiredSwitching a patient to this agent?PA + step therapy — a prior in-class trial usually clears itThis plan gates the class with PA + specialty pharmacy + step therapy. A documented trial (or failure/intolerance) of an in-class agent — which your patient already has — typically satisfies the step requirement, so the switch clears.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K ✓ ✓ ✓ — Ubrelvy 83K ✓ ✓ ✓ — Emgality 61K ✓ ✓ ✓ — Aimovig 56K ✓ ✓ ✓ — Qulipta 45K ✓ ✓ ✓ — Ajovy 24K ✓ ✓ ✓ — Zavzpret 3K ✓ ✓ ✓ — Vyepti 2K ✓ ✓ ✓ — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy. - CGRP inhibitors · migraine(Anthem Blue Cross (Elevance))PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA + quantity limit. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K ✓ — ✓ — Ubrelvy 83K ✓ — ✓ — Emgality 61K ✓ — ✓ — Aimovig 56K ✓ — ✓ — Qulipta 45K ✓ — ✓ — Ajovy 24K ✓ — ✓ — Zavzpret 3K ✓ — ✓ — Vyepti 2K ✓ — ✓ — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy. - MS disease-modifying therapies(Anthem Blue Cross (Elevance))PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA + specialty pharmacy. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K ✓ — ✓ — Copaxone 5K ✓ — ✓ — Avonex 4K ✓ — ✓ — Ocrevus 3K ✓ — ✓ — Vumerity 3K ✓ — ✓ — Aubagio 2K ✓ — ✓ — Tecfidera 2K ✓ — ✓ — Rebif 2K ✓ — ✓ — Mavenclad 1K ✓ — ✓ — Zeposia 1K ✓ — ✓ — Betaseron 1K ✓ — ✓ — Mayzent 849 ✓ — ✓ — Gilenya 839 ✓ — ✓ — Tysabri 566 ✓ — ✓ — Plegridy 509 ✓ — ✓ — Briumvi 155 ✓ — ✓ — Ponvory 79 ✓ — ✓ — Lemtrada 0 ✓ — ✓ — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy.
part d
- CGRP inhibitors · migraine(Centene)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K — — — — Ubrelvy 83K — — — — Emgality 61K — — — — Aimovig 56K — — — — Qulipta 45K — — — — Ajovy 24K — — — — Zavzpret 3K — — — — Vyepti 2K — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - MS disease-modifying therapies(Centene)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K — — — — Copaxone 5K — — — — Avonex 4K — — — — Ocrevus 3K — — — — Vumerity 3K — — — — Aubagio 2K — — — — Tecfidera 2K — — — — Rebif 2K — — — — Mavenclad 1K — — — — Zeposia 1K — — — — Betaseron 1K — — — — Mayzent 849 — — — — Gilenya 839 — — — — Tysabri 566 — — — — Plegridy 509 — — — — Briumvi 155 — — — — Ponvory 79 — — — — Lemtrada 0 — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - CGRP inhibitors · migraine(Unitedhealthcare)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K — — — — Ubrelvy 83K — — — — Emgality 61K — — — — Aimovig 56K — — — — Qulipta 45K — — — — Ajovy 24K — — — — Zavzpret 3K — — — — Vyepti 2K — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - MS disease-modifying therapies(Unitedhealthcare)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K — — — — Copaxone 5K — — — — Avonex 4K — — — — Ocrevus 3K — — — — Vumerity 3K — — — — Aubagio 2K — — — — Tecfidera 2K — — — — Rebif 2K — — — — Mavenclad 1K — — — — Zeposia 1K — — — — Betaseron 1K — — — — Mayzent 849 — — — — Gilenya 839 — — — — Tysabri 566 — — — — Plegridy 509 — — — — Briumvi 155 — — — — Ponvory 79 — — — — Lemtrada 0 — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - CGRP inhibitors · migraine(Humana)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K — — — — Ubrelvy 83K — — — — Emgality 61K — — — — Aimovig 56K — — — — Qulipta 45K — — — — Ajovy 24K — — — — Zavzpret 3K — — — — Vyepti 2K — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - MS disease-modifying therapies(Humana)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K — — — — Copaxone 5K — — — — Avonex 4K — — — — Ocrevus 3K — — — — Vumerity 3K — — — — Aubagio 2K — — — — Tecfidera 2K — — — — Rebif 2K — — — — Mavenclad 1K — — — — Zeposia 1K — — — — Betaseron 1K — — — — Mayzent 849 — — — — Gilenya 839 — — — — Tysabri 566 — — — — Plegridy 509 — — — — Briumvi 155 — — — — Ponvory 79 — — — — Lemtrada 0 — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - MS disease-modifying therapies(Cigna)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K — — — — Copaxone 5K — — — — Avonex 4K — — — — Ocrevus 3K — — — — Vumerity 3K — — — — Aubagio 2K — — — — Tecfidera 2K — — — — Rebif 2K — — — — Mavenclad 1K — — — — Zeposia 1K — — — — Betaseron 1K — — — — Mayzent 849 — — — — Gilenya 839 — — — — Tysabri 566 — — — — Plegridy 509 — — — — Briumvi 155 — — — — Ponvory 79 — — — — Lemtrada 0 — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - CGRP inhibitors · migraine(Cigna)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K — — — — Ubrelvy 83K — — — — Emgality 61K — — — — Aimovig 56K — — — — Qulipta 45K — — — — Ajovy 24K — — — — Zavzpret 3K — — — — Vyepti 2K — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - CGRP inhibitors · migraine(Aetna)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K — — — — Ubrelvy 83K — — — — Emgality 61K — — — — Aimovig 56K — — — — Qulipta 45K — — — — Ajovy 24K — — — — Zavzpret 3K — — — — Vyepti 2K — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - MS disease-modifying therapies(Aetna)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K — — — — Copaxone 5K — — — — Avonex 4K — — — — Ocrevus 3K — — — — Vumerity 3K — — — — Aubagio 2K — — — — Tecfidera 2K — — — — Rebif 2K — — — — Mavenclad 1K — — — — Zeposia 1K — — — — Betaseron 1K — — — — Mayzent 849 — — — — Gilenya 839 — — — — Tysabri 566 — — — — Plegridy 509 — — — — Briumvi 155 — — — — Ponvory 79 — — — — Lemtrada 0 — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - CGRP inhibitors · migraine(Kaiser)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K — — — — Ubrelvy 83K — — — — Emgality 61K — — — — Aimovig 56K — — — — Qulipta 45K — — — — Ajovy 24K — — — — Zavzpret 3K — — — — Vyepti 2K — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. - MS disease-modifying therapies(Kaiser)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K — — — — Copaxone 5K — — — — Avonex 4K — — — — Ocrevus 3K — — — — Vumerity 3K — — — — Aubagio 2K — — — — Tecfidera 2K — — — — Rebif 2K — — — — Mavenclad 1K — — — — Zeposia 1K — — — — Betaseron 1K — — — — Mayzent 849 — — — — Gilenya 839 — — — — Tysabri 566 — — — — Plegridy 509 — — — — Briumvi 155 — — — — Ponvory 79 — — — — Lemtrada 0 — — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low.
commercial qhp
- MS disease-modifying therapies(Molina Healthcare)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Kesimpta 7K ✓ — — — Copaxone 5K ✓ — — — Avonex 4K ✓ — — — Ocrevus 3K ✓ — — — Vumerity 3K ✓ — — — Aubagio 2K ✓ — — — Tecfidera 2K ✓ — — — Rebif 2K ✓ — — — Mavenclad 1K ✓ — — — Zeposia 1K ✓ — — — Betaseron 1K ✓ — — — Mayzent 849 ✓ — — — Gilenya 839 ✓ — — — Tysabri 566 ✓ — — — Plegridy 509 ✓ — — — Briumvi 155 ✓ — — — Ponvory 79 ✓ — — — Lemtrada 0 ✓ — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy. - CGRP inhibitors · migraine(Molina Healthcare)PA requiredSwitching a patient to this agent?PA required — switch supported by prior therapyThis plan requires PA. No step therapy is documented for the class, so the switch is reviewed on standard medical-necessity criteria.Brands & switching · this planSort··
Drug Part D pts Prior auth Step Limit Tier Nurtec 105K ✓ — — — Ubrelvy 83K ✓ — — — Emgality 61K ✓ — — — Aimovig 56K ✓ — — — Qulipta 45K ✓ — — — Ajovy 24K ✓ — — — Zavzpret 3K ✓ — — — Vyepti 2K ✓ — — — Sorted by Part D patients · Medicare CY2023; infused agents (Ocrevus/Tysabri) bill under Part B and read low. Per-drug tier isn't itemized in this policy.
If denied in Washington
📨 Office of Administrative Hearings (OAH)
Unlock the full pack
Full criteria, sources & appeal paths — all 51 states.
You’ve seen the breadth and one state in full. The complete Neurologypack — 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.