Coverage tools
Prior authorization
6,799 Medicare Part D prior-authorization rules indexed from CMS SPUF (Standard Public Use File). Step therapy, quantity limits, tier assignments — authoritative, updated quarterly.
Why only Medicare Part D?
Medicare Part D formularies are published by CMS and we can cite them. Commercial plan rules vary by plan + year + region and aren't reliably published in a machine-readable form — so we don't surface them here. For your commercial plan, check your insurer's formulary PDF directly (“drug list” on the member site) or ask your pharmacist to run a test claim.
| Drug | Payer | PA | Step therapy | Tier |
|---|---|---|---|---|
| Propofol propofol | — Medicare Part D | — | — | — |
| Lithium Carbonate lithium carbonate | — Medicare Part D | — | — | — |
| Tolterodine Tartrate Extended Release tolterodine tartrate | — Medicare Part D | — | — | — |
| LEVOFLOXACIN Levofloxacin | — Medicare Part D | — | — | — |
| SAPROPTERIN DIHYDROCHLORIDE sapropterin dihydrochloride | — Medicare Part D | — | — | — |
| ENBREL etanercept | — Medicare Part D | Yes | — | — |
| LIDOCAINE HYDROCHLORIDE Lidocaine Hydrochloride | — Medicare Part D | — | — | — |
| OXYCODONE HYDROCHLORIDE OXYCODONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Multrys Trace Elements Injection 4 | — Medicare Part D | — | — | — |
| JAYTHARI Deflazacort | — Medicare Part D | — | — | — |
| Cholestyramine Light cholestyramine light | — Medicare Part D | — | — | — |
| Tiagabine Hydrochloride Tiagabine Hydrochloride | — Medicare Part D | — | — | — |
| XTRENBO Denosumab-qbde | — Medicare Part D | Yes | — | — |
| Bumetanide Bumetanide | — Medicare Part D | — | — | — |
| OZEMPIC, RYBELSUS | — Medicare Part D | Yes | — | — |
| Korlym Mifepristone | — Medicare Part D | — | — | — |
| Premarin estrogens, conjugated | — Medicare Part D | — | — | — |
| Bicalutamide Bicalutamide | — Medicare Part D | — | — | — |
| Esomeprazole Magnesium esomeprazole magnesium | — Medicare Part D | — | — | — |
| Gozellix GOZETOTIDE | — Medicare Part D | — | — | — |
| Lupron Depot leuprolide acetate | — Medicare Part D | — | — | — |
| Kuvan SAPROPTERIN DIHYDROCHLORIDE | — Medicare Part D | — | — | — |
| QUINAPRIL Quinapril Hydrochloride | — Medicare Part D | — | — | — |
| Verzenio abemaciclib | — Medicare Part D | — | — | — |
| LICART diclofenac epolamine | — Medicare Part D | — | — | — |
| Vinblastine Sulfate VINBLASTINE SULFATE | — Medicare Part D | — | — | — |
| Diclofenac Sodium/Misoprostol DICLOFENAC-SODIUM-MISOPROSTOL Diclofenac Sodium/Misoprostol | — Medicare Part D | — | — | — |
| Multi-Vitamin Drops with Fluoride and Iron | — Medicare Part D | — | — | — |
| Articaine HCl and Epinephrine articaine hydrochloride and epinephrine bitartrate | — Medicare Part D | — | — | — |
| GRISEOFULVIN MICROSIZE griseofulvin | — Medicare Part D | — | — | — |
| PACLITAXEL Paclitaxel | — Medicare Part D | — | — | — |
| AQUASOL A VITAMIN A PALMITATE | — Medicare Part D | — | — | — |
| BIMATOPROST Bimatoprost | — Medicare Part D | — | — | — |
| neffy epinephrine | — Medicare Part D | — | — | — |
| Gablofen Baclofen Injection | — Medicare Part D | — | — | — |
| LOSARTAN POTASSIUM 100 mg LOSARTAN POTASSIUM | — Medicare Part D | — | — | — |
| INDOMETHACIN Indomethacin | — Medicare Part D | — | — | — |
| Firdapse amifampridine phosphate | — Medicare Part D | — | — | — |
| Dexatran Multivitamin | — Medicare Part D | — | — | — |
| Vumerity diroximel fumarate | — Medicare Part D | — | — | — |
| Symvess ACELLULAR TISSUE ENGINEERED VESSEL | — Medicare Part D | — | — | — |
| Nuvigil Armodafinil | — Medicare Part D | — | — | — |
| Amantadine HCl Amantadine HCL | — Medicare Part D | — | — | — |
| Xipere triamcinolone acetonide | — Medicare Part D | — | — | — |
| Rubraca rucaparib | — Medicare Part D | — | — | — |
| Manganese Chelidonium Majus, Iodium, Lycopus Virginicus, Ginkgo Biloba, Pinus Sylvestris, Fucus Vesiculosus, Spongia Tosta, Germanium Sesquioxide, Hypophysis Suis, Thyroidinum (Suis), Cysteinum, Manganese Gluconate, Alpha-Ketoglutaricum Acidum, Calcarea Carbonica, Ferrum Iodatum, Fumaricum Acidum, Kali Iodatum, Natrum Oxalaceticum, Pulsatilla (Vulgaris), Argentum Metallicum, Aurum Metallicum, Cuprum Metallicum, Eugenol, Formalinum, Lidocaine, Mercurius Solubilis, Molybdenum Metallicum, Niccolum Metallicum, | — Medicare Part D | — | — | — |
| Nextstellis drospirenone and estetrol | — Medicare Part D | — | — | — |
| Thiothixene Thiothixene | — Medicare Part D | — | — | — |
| Zoledronic Acid Zoledronic Acid | — Medicare Part D | — | — | — |
| OPIPZA ARIPIPRAZOLE | — Medicare Part D | — | — | — |