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 |
|---|---|---|---|---|
| Amiloride Hydrochloride amiloride hydrochloride | — Medicare Part D | — | — | — |
| Orphenadrine Citrate, Aspirin and Caffeine Orphenadrine Citrate, Aspirin and Caffeine | — Medicare Part D | — | — | — |
| SKYCLARYS omaveloxolone | — Medicare Part D | — | — | — |
| Librax Chlordiazepoxide Hydrochloride and Clidinium Bromide | — Medicare Part D | — | — | — |
| REZVOGLAR KWIKPEN Insulin glargine-aglr | — Medicare Part D | Yes | — | — |
| ACD-A Anticoagulant Citrate Dextrose Solution Formula A | — Medicare Part D | — | — | — |
| Riabni rituximab-arrx | — Medicare Part D | — | — | — |
| BICILLIN C-R 900/300 penicillin G benzathine and penicillin G procaine | — Medicare Part D | Yes | — | — |
| Cleocin Phosphate clindamycin phosphate | — Medicare Part D | — | — | — |
| Mefenamic Acid Mefenamic Acid | — Medicare Part D | — | — | — |
| SKYSONA elivaldogene autotemcel | — Medicare Part D | — | — | — |
| Nitazoxanide Nitazoxanide | — Medicare Part D | — | — | — |
| Olmesartan Medoxomil Olmesartan Medoxomil | — Medicare Part D | — | — | — |
| Oxygen Refrigerated Liquid, Oxygen Compressed Gas | — Medicare Part D | — | — | — |
| Thiamine THIAMINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Technescan PYP Technetium Tc 99m Pyrophosphate | — Medicare Part D | — | — | — |
| Valtoco diazepam | — Medicare Part D | — | — | — |
| TESTOSTERONE ENANTHATE Testosterone Enanthate | — Medicare Part D | — | — | — |
| IYUZEH Latanoprost Ophthalmic Solution 0.005% | — Medicare Part D | — | — | — |
| Ciprofloxacin Otic Ciprofloxacin | — Medicare Part D | — | — | — |
| Magnesium Chloride Leucine, Phenylalanine, Lysine, Methionine, Isoleucine, Valine, Histidine, Threonine, Tryptophan, Alanine, Glycine, Arginine, Proline, Serine, Tyrosine, Sodium Acetate, Dibasic Potassium Phosphate, Magnesium Chloride, Sodium Chloride, Calcium Chloride, Dextrose | — Medicare Part D | — | — | — |
| Zafirlukast Zafirlukast | — Medicare Part D | — | — | — |
| Choletec Mebrofenin | — Medicare Part D | — | — | — |
| REZENOPY naloxone HCl | — Medicare Part D | — | — | — |
| Losortan Potassium Losartan Potassium | — Medicare Part D | — | — | — |
| EPIPEN, EPIPEN JR | — Medicare Part D | — | — | — |
| Clozapine Clozapine | — Medicare Part D | — | — | — |
| Kurvelo levonorgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| Posaconazole POSACONAZOLE | — Medicare Part D | — | — | — |
| Enoxaparin Sodium enoxaparin sodium | — Medicare Part D | — | — | — |
| Physician EZ Use Joint Tunnel and Trigger Kit II LIDOCAINE HYDROCHLORIDE, TRIAMCINOLONE ACETONIDE, POVIDONE-IODINE | — Medicare Part D | — | — | — |
| Imcivree setmelanotide | — Medicare Part D | — | — | — |
| Jardiance Empagliflozin | — Medicare Part D | — | — | — |
| SAPHRIS Asenapine Maleate | — Medicare Part D | — | — | — |
| Phenoxybenzamine Hydrochloride PHENOXYBENZAMINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| BIZENGRI Zenocutuzumab | — Medicare Part D | — | — | — |
| Difluprednate Ophthalmic Emulsion Difluprednate Ophthalmic | — Medicare Part D | — | — | — |
| IMKELDI imatinib oral | — Medicare Part D | — | — | — |
| EPOGEN epoetin alfa | — Medicare Part D | Yes | — | — |
| UBRELVY ubrogepant | — Medicare Part D | — | — | — |
| SOAANZ Torsemide | — Medicare Part D | — | — | — |
| Sulfasalazine Sulfasalazine | — Medicare Part D | — | — | — |
| Aminocaproic Acid aminocaproic acid | — Medicare Part D | — | — | — |
| PENICILLIN G POTASSIUM PENICILLIN G | — Medicare Part D | — | — | — |
| Aripiprazole Aripiprazole | — Medicare Part D | — | — | — |
| ROSUVASTATIN, ROSUVASTATIN CALCIUM | — Medicare Part D | — | — | — |
| CALQUENCE acalabrutinib | — Medicare Part D | — | — | — |
| Dextrose And Sodium Chloride DEXTROSE MONOHYDRATE and SODIUM CHLORIDE | — Medicare Part D | — | — | — |
| Urea 40 Percent Urea | — Medicare Part D | — | — | — |
| ROPINIROLE HYDROCHLORIDE Ropinirole Hydrochloride | — Medicare Part D | — | — | — |