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General Information
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Table
General Information
| State / Territory | Open Formulary | Excluded Drugs | Separate formularies for full-pay medication clients vs. ADAP-funded insurance clients? | Additional Drugs Available with Clinical Provider Approval | Prior Authorizations | Drugs Requiring Prior Authorization |
|---|---|---|---|---|---|---|
| Alabama | No | Yes | Yes | Yes | Sunlenca (Lenacapavir) | |
| Alaska | No | No | No | No | ||
| Arizona | No | Yes | Yes | Yes | HIV Long-Acting Antiretroviral Therapy (LAART); Serostim (Somatropin); Sunlenca (Lenacapavir) | |
| Arkansas | No | No | No | Yes | All Hepatitis C (HCV) medications; Entecavir; Tecovirimat (TPOXX); Pifeltro; Delstrigo; Selzentry; Trogarzo; Rukobia; Cabenuva; Sunlenca | |
| California | Yes | Certain biologics; monoclonal antibodies; chemotherapeutics; and controlled substances (excluded for cost or safety concerns) | No | No | Yes | Extensive list including Cabotegravir; Carbamazepine; Chorionic Gonadotropin; Fentanyl; Ibalizumab (Trogarzo); Lenacapavir (Sunlenca); Methadone; Methylphenidate; Somatropin; and Tesamorelin |
| Colorado | No | No | Yes | No | ||
| Connecticut | No | No | No | Yes | Serostim (Somatropin); Xyosted (Testosterone Enanthate) | |
| Delaware | No | No | No | Yes | Rukobia; Sunlenca; Selzentry | |
| District of Columbia | No | No | Yes | Yes | Subutex; Suboxone; Daliresp; benzodiazepines (Lorazepam, Diazepam); Daraprim; Sunlenca; Trogarzo; HCV medications (Mavyret, Harvoni); Cabenuva; Dronabinol; Somatropin; Epoetin | |
| Georgia | No | No | No | Yes | Rukobia; Selzentry; Symtuza; Trogarzo; Cabenuva; Sunlenca; HCV medications (Epclusa, Harvoni, Mavyret, Zepatier); Ribavirin | |
| Guam | No | No | No | No | ||
| Hawaii | No | No | No | No | ||
| Idaho | No | No | No | Yes | Vemlidy (clinical PA for off-label HIV use); Hormone medications (requires provider certification regarding gender identity per state code); Trogarzo; Subutex; Epidiolex; Mytesi; ADHD medications (Adderall, Vyvanse); Dupixent | |
| Illinois | Yes | Erectile Dysfunction (ED) medications; Infertility medications; Weight loss / Obesity medications; Cosmetic agents (Botox, Minoxidil); Experimental / Investigational drugs; OTC medications; Homeopathic / Herbal medications. | No | No | Yes | Cabenuva; Sunlenca; Trogarzo; Rukobia; Selzentry; HCV DAAs (Mavyret, Epclusa, Harvoni); Serostim; Egrifta SV; Dronabinol; Megestrol; and High-cost medications (>$5,000 / month) |
| Indiana | No | Yes | No | No | ||
| Iowa | Yes | Abortifacients; Durable Medical Equipment (DME); ED and Fertility medications; Hyaluronic Acid derivatives; IV Immune Globulin; Injectable muscle relaxants; Medical Cannabidiol; Schedule II Controlled Substances (Percocet, Adderall, Hydrocodone) | No | No | Yes | Cabenuva and Sunlenca are covered but restricted to medical necessity documentation for non-cosmetic Botox usage |
| Kansas | No | No | No | No | ||
| Kentucky | No | No | No | No | ||
| Louisiana | No | Yes | No | Yes | Pegasys; HCV medications (Zepatier, Mavyret, Harvoni, Sovaldi, Epclusa, Vosevi) | |
| Maine | No | No | Yes | Yes | Buprenorphine; Delstrigo; Eliquis; Harvoni; Selzentry; Trogarzo; Ozempic; Vosevi | |
| Maryland | Yes | Opioids; PDE Inhibitors (Erectile Dysfunction medications) | No | No | No | |
| Massachusetts | Yes | Finasteride (except for prostate disorders); Minoxidil (Rogaine); Cosmetic medications; Herbal medications | No | No | No | |
| Michigan | No | No | No | Yes | Fentanyl; Methadone; Oxycodone; Lidoderm patches; Trogarzo; Sunlenca; Pyrimethamine; Testosterone (topical); GLP-1s (Trulicity, Victoza); Epoetin Alfa | |
| Missouri | No | No | No | No | ||
| Montana | No | No | No | Yes | Mounjaro; Ozempic | |
| Nebraska | Yes | Cosmetic enhancements; ED medications; Weight loss medications | No | Yes | Yes | Schedule II medications; specific high-dollar pain medications |
| Nevada | No | No | No | Yes | Egrifta / Egrifta SV; Trogarzo; HCV medications (Epclusa, Harvoni, Mavyret, Sovaldi, Vosevi, Zepatier) | |
| New Hampshire | Yes | Compound drugs; botulinum toxin compounds and cosmetics; general cosmetic products; hair growth stimulants; erectile dysfunction drugs; fertility drugs; mifepristone; herbal medications; over-the-counter drugs (with some exceptions); hyaluronic acid derivatives; immune globulin intravenous; injectable muscle relaxants; recombinant human growth hormone; and gene therapy | No | No | Yes | Clinical PA criteria apply to specific high-cost or specialty medications as defined in the NH ADAP clinical criteria list (including Buprenorphine / Naloxone and select ARV treatments) |
| New Jersey | Yes | Weight loss medications; ED products; OTC products (all types) | No | No | Yes | Cabenuva; Aptivus; Fuzeon; Selzentry; Daraprim; Serostim; Egrifta; Marinol; HCV DAAs; GLP-1 / GIP agonists; ADHD stimulants |
| New Mexico | Yes | None | No | Yes | No | |
| New York | No | No | No | No | ||
| North Carolina | No | Yes | No | No | ||
| North Dakota | Yes | Abortifacients; Acne medications; All controlled substances; Antipsychotics; Antirheumatic injectables; Botulinum Toxin; Chemotherapeutic agents; Compounded medications; Cosmetic medications; Fertility medications | No | Yes | No | |
| Ohio | Yes | Abortifacients (Mifepristone); Fertility medications; Alzheimers medication (Aduhelm); Finasteride (except for BPH); Cosmetic / Acne medications; HCV treatments; Botulinum Toxin; Herbal medications; Schedule II-V Controlled Substances (with limited exceptions) | No | No | No | |
| Oklahoma | No | Yes | Yes | Yes | Cabenuva; HCV treatments | |
| Oregon | Yes | Anorexiants (Weight loss / gain); Fertility purposes; ED purposes; Cosmetic purposes; Herbal / Nutritional supplements; most OTCs | Yes | Yes | Yes | HCV medications (Mavyret, Harvoni, Epclusa, Zepatier); Serostim; Egrifta; Tadalafil; Sildenafil |
| Pennsylvania | No | No | No | No | ||
| Puerto Rico | No | No | No | Yes | Cabenuva; Rukobia; Selzentry; Trogarzo; Sunlenca; Egrifta; Ozempic; Rybelsus; HCV medications (Epclusa, Harvoni, Mavyret, Sovaldi, Vosevi, Zepatier) | |
| Rhode Island | Yes | Weight loss drugs | No | No | Yes | Cabenuva; Sunlenca |
| South Carolina | No | No | No | Yes | Selzentry; Sunlenca; Trogarzo; Egrifta | |
| South Dakota | No | No | No | No | ||
| Tennessee | No | Yes | Yes | No | ||
| Texas | No | Yes | No | Yes | LAI: Cabenuva | |
| Utah | No | Yes | Yes | Yes | Cabenuva | |
| Vermont | No | No | No | No | ||
| Virginia | No | Yes | No | No | ||
| Washington | No | Yes | No | Yes | Egrifta; Sunlenca | |
| Wisconsin | No | No | No | No | ||
| Wyoming | No | No | Yes | Yes | Hemophilia medications; Botulinum Toxin; Gonadotropin; Finasteride (except for BPH); IV Immune Globulin; Recombinant Growth Hormone (HGH). Program also apply a cost-based PA for any claim exceeding program dollar caps. |