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 |
|---|---|---|---|---|
| Ezetimibe and Simvastatin Ezetimibe and Simvastatin | — Medicare Part D | — | — | — |
| CLINDAMYCIN HYDROCHLORIDE Clindamycin Hydrochloride | — Medicare Part D | — | — | — |
| Clobetasol Propionate ANDA Clobetasol Propionate | — Medicare Part D | — | — | — |
| Entacapone entacapone | — Medicare Part D | — | — | — |
| Fosinopril Sodium and Hydrochlorothiazide Fosinopril Sodium and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Verapamil Hydrochloride verapamil hydrochloride | — Medicare Part D | — | — | — |
| Marbeta 25 Kit Betamethasone Sodium Phosphate and Betamethasone Acetate, Bupivacaine Hydrochloride, Povidine Iodine | — Medicare Part D | — | — | — |
| DORZOLAMIDE HYDROCHLORIDE TIMOLOL MALETAE ddorzolamide hydrochloride timolol maleate | — Medicare Part D | — | — | — |
| SUNITINIB MALATE Sunitinib malate | — Medicare Part D | — | — | — |
| Carbogen Carbogen | — Medicare Part D | — | — | — |
| DOPamine Hydrochloride Dopamine Hydrochloride | — Medicare Part D | — | — | — |
| Hydrocortisone Cream Hydrocortisone | — Medicare Part D | — | — | — |
| Byooviz ranibizumab-nuna | — Medicare Part D | — | — | — |
| Femara letrozole | — Medicare Part D | — | — | — |
| LURBIRO Flurbiprofen | — Medicare Part D | — | — | — |
| Cobalefol VITAMIN | — Medicare Part D | — | — | — |
| Morphine Sulfate Extended Release Morphine Sulfate | — Medicare Part D | — | — | — |
| Banzel rufinamide | — Medicare Part D | — | — | — |
| Atovaquone Atovaquone | — Medicare Part D | — | — | — |
| Ionosol MB and Dextrose DEXTROSE MONOHYDRATE, SODIUM LACTATE, POTASSIUM CHLORIDE, MAGNESIUM CHLORIDE, POTASSIUM PHOSPHATE, MONOBASIC, and SODIUM PHOSPHATE, MONOBASIC, MONOHYDRATE | — Medicare Part D | — | — | — |
| Caspofungin Acetate Caspofungin Acetate | — Medicare Part D | — | — | — |
| DOXAPRAM HYDROCHLORIDE DOXAPRAM HYDROCHLORIDE | — Medicare Part D | — | — | — |
| LYVISPAH baclofen | — Medicare Part D | — | — | — |
| Prochlorperazine Prochlorperazine Maleate | — Medicare Part D | — | — | — |
| Brevibloc esmolol hydrochloride | — Medicare Part D | — | — | — |
| Cytalux Pafolacianine injection | — Medicare Part D | — | — | — |
| Esmolol Hydrochloride Esmolol Hydrochloride | — Medicare Part D | — | — | — |
| Ezetimibe and Simvastatin Ezetimibe and Simvastatin | — Medicare Part D | — | — | — |
| Zoledronic Acid Zoledronic Acid | — Medicare Part D | — | — | — |
| Oxygen Helium Mixture 20/80 Oxygen Helium Mixture 20/80 | — Medicare Part D | — | — | — |
| Nayzilam midazolam | — Medicare Part D | — | — | — |
| Sorafenib sorafenib | — Medicare Part D | — | — | — |
| FUROSCIX furosemide injection 80 mg/ 10 mL | — Medicare Part D | — | — | — |
| YCANTH Cantharidin | — Medicare Part D | — | — | — |
| Zovirax acyclovir | — Medicare Part D | — | — | — |
| BUPRENORPHINE HYDROCHLORIDE and NALOXONE HYDROCHLORIDE DIHYDRATE BUPRENORPHINE HYDROCHLORIDE and NALOXONE HYDROCHLORIDE DIHYDRATE | — Medicare Part D | — | — | — |
| POTASSIUM CHLORIDE EXTENDED RELEASE Potassium chloride | — Medicare Part D | — | — | — |
| ALPHAGAN P brimonidine tartrate | — Medicare Part D | — | — | — |
| doxycycline, Doxycycline Hyclate, doxycycline hyclate | — Medicare Part D | — | — | — |
| Thyrogen THYROTROPIN ALFA | — Medicare Part D | — | — | — |
| PCXX RASPBERRY NEUTRAL GL Sodium Fluoride | — Medicare Part D | — | — | — |
| PROPRANOLOL HYDROCHLORIDE propranolol hydrochloride | — Medicare Part D | — | — | — |
| RHAPSIDO remibrutinib | — Medicare Part D | — | — | — |
| Valacyclovir Hydrochloride Valacyclovir Hydrochloride | — Medicare Part D | — | — | — |
| Sodium Oxybate Sodium Oxybate | — Medicare Part D | — | — | — |
| Veregen sinecatechins | — Medicare Part D | — | — | — |
| PRUCALOPRIDE PRUCALOPRIDE | — Medicare Part D | — | — | — |
| Inderal XL propranolol hydrochloride | — Medicare Part D | — | — | — |
| PreviDent 5000 Kids Sodium Fluoride | — Medicare Part D | — | — | — |
| Nymalize nimodipine | — Medicare Part D | — | — | — |