I Built a Crawler for Medica’s Drug PA Policies. Here’s What I Found—and Why It’s Bigger Than Medica

Medica maintains 681 commercial drug prior authorization policies—the largest count I’ve crawled so far.

  • 8 posted in January 2026
  • 20 re-posted in the last 30 days
  • 98 in the last 60 days

But here’s the real story: every single policy is sourced from Express Scripts.

This isn’t just Medica. It’s a window into ESI’s commercial policy infrastructure—the same backbone powering PA decisions for multiple plan sponsors nationwide.

What Changed Recently

December was busy. Four distinct batch updates:

Date (2025)Policies
Dec 524
Dec 1315
Dec 1920
Dec 3112

The Dec 31 batch—right before benefit year reset—hit complement inhibitors (Zilbrysq), hepatology (Rezdiffra), inflammatory conditions (Omvoh, Zymfentra), and rare disease (Forzinity for Barth syndrome).

If your specialty pharmacy intake workflows weren’t updated before January 1, you started the year with stale criteria.

The Complexity Signal

Two policies stand out by sheer size:

  • Inflammatory Conditions – Care Value Policy: 1,091 KB. That’s not a policy—it’s a coverage rulebook.
  • GLP-1 Weight Loss Policy: 439 KB, updated Dec 5. Wegovy, Zepbound, and the entire class in one dense document.

Size correlates with complexity: multiple indications, layered step therapy, documentation requirements that vary by scenario. These are the policies where denials hide in the details.

Atopic Dermatitis Coverage

Medica/ESI maintains 8 AD-related policies:

  • Dupixent (reposted Nov 7)
  • Rinvoq / Rinvoq LQ (reposted Oct 23)
  • Adbry, Cibinqo, Ebglyss
  • Topical Agents for AD Step Therapy (reposted Nov 4)

Why This Matters

If you’re managing access for a product that touches ESI’s commercial book, this data isn’t just “Medica.” It’s directional intelligence for how ESI operationalizes coverage.

I’m building infrastructure to track this across plans:

  • Automated crawling with cryptographic version hashes
  • Structured extraction of approval criteria, step therapy, and denial logic
  • Delta alerts when policies shift

What’s Next

Now live: Highmark, UnitedHealthcare

Up next: Cigna, BCBS Illinois—rounding out a market sample basket that covers regional, national, and PBM-administered plans.

If you’re a benefits consultant, specialty pharmacy, or market access team—this is the kind of intelligence that changes how you prepare.

About Andrew

Hey! I’m Andrew Gilberto Vargas, a pharmacist and writer. I reflect on concepts that shape pharmacy benefits, drug access, leadership and meaning-making. Always curious, always learning.

Andrew Vargas, PharmD

About the Author

Andrew Vargas, PharmD is a Pharmacist practicing watchdoggery and founder of Pharmacist Write. He builds coverage intelligence tools and writes about what pharmacy benefits managers would prefer stayed invisible—turning policy into something patients, consultants, and purchasers can actually use.

🧠 Read full bio · View all articles