Clinical specialty-society guidelines

AASLD-IDSA HCV Guidance opposes fibrosis-stage and sobriety restrictions on HCV antivirals — critical for HCV antiviral appeals.

AACE/ACE Clinical Practice Guidelines for endocrine conditions. Strong on obesity pharmacotherapy + diabetes pharmacotherapy.

ACR Guidelines are the US standard for rheumatology. Biologic recommendations drive the bulk of biologic appeals.

ADA Standards of Care in Diabetes is the most-cited diabetes guideline globally. GLP-1 agonist + SGLT2 inhibitor recommendations are at Level A evidence.

AGA Clinical Practice Guidelines for GI conditions. IBD biologic guidelines are particularly important for appeals.

AHA/ACC Joint Guidelines are the dominant US cardiology standard. Class I + IIa recommendations are the strongest appeal-letter cites.

APA Practice Guidelines for psychiatric disorders. Essential for MHPAEA parity appeals where insurers apply stricter rules to mental health.

ASAM Criteria + ASAM Practice Guidelines are the dominant US standard for SUD care. Essential for MHPAEA parity appeals and SUD treatment-level appeals.

ATS guidelines for asthma, COPD, pulmonary fibrosis, sleep apnea. Severe asthma biologic appeals rely heavily on ATS criteria.

NCCN Guidelines are the dominant US oncology standard. NCCN Compendium-supported uses are required Medicare and Medicaid coverage and influence commercial plan coverage.

Obesity Society + Endocrine Society guidelines recognize obesity as a chronic disease requiring pharmacotherapy — directly contradicts plan-level weight-loss-exclusion language.

USPSTF A + B recommendations are required to be covered at $0 cost-sharing under ACA §2713. The strongest single cite for preventive coverage appeals.