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 |
|---|---|---|---|---|
| Sildenafil Sildenafil | — Medicare Part D | — | — | — |
| MVASI bevacizumab-awwb | — Medicare Part D | — | — | — |
| Cardura XL doxazosin mesylate | — Medicare Part D | — | — | — |
| Dextroamphetamine Sulfate Extended-Release dextroamphetamine sulfate | — Medicare Part D | — | — | — |
| Tyrvaya varenicline | — Medicare Part D | — | — | — |
| OHM Pituitarum Complex Adrenal Gland, Adrenocorticotrophin, Cerebrum, Liver Gland, Pituitarum Posterium Gland, Placenta, Thyroidinum. | — Medicare Part D | — | — | — |
| DUREZOL difluprednate | — Medicare Part D | — | — | — |
| ProAir RespiClick Albuterol Sulfate | — Medicare Part D | — | — | — |
| PrednisoLONE Prednisolone | — Medicare Part D | — | — | — |
| Sodium Fluoride 5000 ppm Enamel Protect Sodium Fluoride1.1%, Potassium Nitrate 5% | — Medicare Part D | — | — | — |
| Bromocriptine Mesylate Bromocriptine Mesylate | — Medicare Part D | — | — | — |
| GLYCYRRHIZA GLABRA Allium Sativum, Berberis Vulgaris, Glycyrrhiza Glabra, Lappa Major, Stillingia Sylvatica, Trifolium Pratense, Ascorbicum Acidum, Cysteinum, L-Methionine, Phytolacca Decandra, Thyroidinum (Suis), Carbolicum Acidum, Formalinum, Lycopodium Clavatum, Natrum Muriaticum, Nux Vomica, Boron, Arsenicum Album, Aluminum Metallicum, Antimonium Crudum, Argentum Metallicum, Mercurius Solubilis, Plumbum Metallicum, Lanthanum Metallicum, Niobium Metallicum, Niobium, | — Medicare Part D | — | — | — |
| Nitrofurantoin Oral Suspension NITROFURANTOIN | — Medicare Part D | — | — | — |
| Ilaris canakinumab | — Medicare Part D | — | — | — |
| Nutralyn Multivitamin | — Medicare Part D | — | — | — |
| Sincalide sincalide | — Medicare Part D | — | — | — |
| Diflucan fluconazole | — Medicare Part D | — | — | — |
| NITROSTAT nitroglycerin | — Medicare Part D | — | — | — |
| SOLIFENACIN SUCCINATE Solifenacin Succinate | — Medicare Part D | — | — | — |
| TEPMETKO Tepotinib Hydrochloride | — Medicare Part D | — | — | — |
| Betamethasone Dipropionate USP, 0.05% Betamethasone Dipropionate USP, 0.05% | — Medicare Part D | — | — | — |
| Eulexin Flutamide | — Medicare Part D | — | — | — |
| Nitrous Oxide NITROUS OXIDE | — Medicare Part D | — | — | — |
| Hydroquinone 4% Hydroquinone | — Medicare Part D | — | — | — |
| ISOTRETINOIN isotretinoin | — Medicare Part D | — | — | — |
| Wakix PITOLISANT HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Xermelo telotristat ethyl | — Medicare Part D | — | — | — |
| Paricalcitol Paricalcitol | — Medicare Part D | — | — | — |
| KAZANO alogliptin and metformin hydrochloride | — Medicare Part D | — | — | — |
| BROMFENAC SODIUM Bromfenac Sodium | — Medicare Part D | — | — | — |
| Helleborus niger Kidney (Suis), Abrotanum, Anacardium Orientale, Baryta Muriatica, Calcarea Carbonica, Calcarea Phosphorica, Glandula Suprarenalis Suis, Graphites, Helleborus Niger, Hepar Suis, Hypothalamus Suis, Ignatia Amara, Lycopodium Clavatum, Secale Cornutum, Silicea, Thymus (Suis), Thyroidinum (Suis) | — Medicare Part D | — | — | — |
| Zithromax azithromycin dihydrate | — Medicare Part D | — | — | — |
| TAPENTADOL Tapentadol Hydrochloride | — Medicare Part D | — | — | — |
| Philith Norethindrone and Ethinyl Estradiol Tablets | — Medicare Part D | — | — | — |
| Fludeoxyglucose F 18 Fludeoxyglucose F-18 | — Medicare Part D | — | — | — |
| ALYMSYS bevacizumab-maly | — Medicare Part D | — | — | — |
| Phexx lactic acid, L-, citric acid monohydrate, and potassium bitartrate | — Medicare Part D | — | — | — |
| TECHNEGAS Kit for the preparation of technetium Tc 99m-labeled carbon inhalation aerosol | — Medicare Part D | — | — | — |
| Silver Nitrate Applicators Silver Nitrate Applicators | — Medicare Part D | — | — | — |
| Methohexital Sodium Methohexital Sodium | — Medicare Part D | — | — | — |
| Clobetasol Propionate Cream, 0.05% Clobetasol Propionate Cream, 0.05% | — Medicare Part D | — | — | — |
| Meprobamate Meprobamate | — Medicare Part D | — | — | — |
| Tridacaine II Lidocaine | — Medicare Part D | — | — | — |
| Vagifem estradiol | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 8% and Sulfur 4% Cleanser SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| DABIGATRAN Dabigatran | — Medicare Part D | — | — | — |
| Bupivacaine HCl BUPIVACAINE HCl | — Medicare Part D | — | — | — |
| ROCURONIUM BROMIDE ROCURONIUM BROMIDE | — Medicare Part D | — | — | — |
| Infant Dextrose Dextrose | — Medicare Part D | — | — | — |
| Skyla Levonorgestrel | — Medicare Part D | — | — | — |