Differences in Prior Authorization Rules in State Medicaid MCO and FFS Pharmacy Benefit
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As of July 1, 2019
| Location | Prior Authorization or Step Therapy Requirements for MCOs Relative to FFS |
|---|---|
| United States | |
| Alabama | N/A |
| Alaska | N/A |
| Arizona | NR |
| Arkansas | Required to be no more restrictive |
| California | Permitted to be more restrictive |
| Colorado | Required to be no more restrictive |
| Connecticut | N/A |
| Delaware | Required to be no more restrictive |
| District of Columbia | Required to be no more restrictive |
| Florida | Required to be no more restrictive |
| Georgia | Required to be no more restrictive |
| Hawaii | Varies |
| Idaho | N/A |
| Illinois | Required to be no more restrictive |
| Indiana | Other |
| Iowa | Required to be the same |
| Kansas | Required to be the same |
| Kentucky | Required to be no more restrictive |
| Louisiana | Required to be no more restrictive |
| Maine | N/A |
| Maryland | Permitted to be more restrictive |
| Massachusetts | Required to be no more restrictive |
| Michigan | Other |
| Minnesota | Varies |
| Mississippi | Required to be no more restrictive |
| Missouri | N/A |
| Montana | N/A |
| Nebraska | Required to be no more restrictive |
| Nevada | Required to be no less restrictive |
| New Hampshire | Required to be no more restrictive |
| New Jersey | Varies |
| New Mexico | Required to be no less restrictive |
| New York | Required to be no more restrictive |
| North Carolina | N/A |
| North Dakota | Required to be no more restrictive |
| Ohio | Required to be no more restrictive |
| Oklahoma | N/A |
| Oregon | Required to be no more restrictive |
| Pennsylvania | Required to be no more restrictive |
| Rhode Island | Required to be no more restrictive |
| South Carolina | Varies |
| South Dakota | N/A |
| Tennessee | N/A |
| Texas | Required to be no more restrictive |
| Utah | NR |
| Vermont | N/A |
| Virginia | Required to be no more restrictive |
| Washington | Required to be no more restrictive |
| West Virginia | N/A |
| Wisconsin | N/A |
| Wyoming | N/A |