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 |
|---|---|---|---|---|
| Diethylpropion Hydrochloride DIETHYLPROPION HYDROCHLORIDE | — Medicare Part D | — | — | — |
| XYOSTED testosterone enanthate | — Medicare Part D | — | — | — |
| Trelstar triptorelin pamoate | — Medicare Part D | Yes | — | — |
| AMOXICILLIN AND CLAVULANATE POTASSIUM Amoxicillin and Clavulanate Potassium | — Medicare Part D | — | — | — |
| Elliotts B sodium cation, sodium bicarbonate, anhydrous dextrose, magnesium sulfate, potassium chloride, calcium chloride, sodium phosphate | — Medicare Part D | — | — | — |
| MOXIFLOXACIN MOXIFLOXACIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| TRICITRATES Tricitrates | — Medicare Part D | — | — | — |
| RISPERIDONE Risperidone | — Medicare Part D | — | — | — |
| Tizanidine HCl Tizanidine HCL | — Medicare Part D | — | — | — |
| UDSx Medicated System Furosemide, Benzalkonium Chloride | — Medicare Part D | — | — | — |
| KLAYESTA Nystatin Topical Powder | — Medicare Part D | — | — | — |
| ADAPALENE AND BENZOYL PEROXIDE adapalene and benzoyl peroxide topical | — Medicare Part D | — | — | — |
| Nitrofurantoin Monohydrate/ Macrocrystalline Nitrofurantoin Monohydrate/Macrocrystalline | — Medicare Part D | — | — | — |
| Ketamine Hydrochloride ketamine hydrochloride | — Medicare Part D | — | — | — |
| BORUZU Bortezomib | — Medicare Part D | — | — | — |
| Anticoagulant Citrate Dextrose A Anhydrous Citric Acid, Dextrose Monohydrate, and Trisodium Citrate Dihydrate | — Medicare Part D | — | — | — |
| VOXZOGO 0.4mg, VOXZOGO 0.56mg, VOXZOGO 1.2mg | — Medicare Part D | Yes | — | — |
| ZYNLONTA loncastuximab tesirine | — Medicare Part D | — | — | — |
| NP THYROID 90 LEVOTHYROXINE, LIOTHYRONINE | — Medicare Part D | — | — | — |
| LILETTA Levonorgestrel | — Medicare Part D | — | — | — |
| NARCAN NALOXONE HCI NARCAN NALOXONE HCI | — Medicare Part D | — | — | — |
| VORANIGO vorasidenib | — Medicare Part D | — | — | — |
| Doxy 100 DOXYCYCLINE | — Medicare Part D | — | — | — |
| LEVONORGESTREL AND ETHINYL ESTRADIOL levonorgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| AmBisome amphotericin B | — Medicare Part D | — | — | — |
| Regadenoson Regadenoson | — Medicare Part D | — | — | — |
| Metronidazole Vaginal Gel, 0.75% | — Medicare Part D | — | — | — |
| Reconstituted Air RECONSTITUTED AIR | — Medicare Part D | — | — | — |
| ARGATROBAN Argatroban | — Medicare Part D | — | — | — |
| TIVDAK tisotumab vedotin | — Medicare Part D | — | — | — |
| Enoxiluv Kit Enoxaparin Sodium, Isopropyl Alcohol | — Medicare Part D | — | — | — |
| Ionite H Sodium Fluoride, Potassium Nitrate | — Medicare Part D | — | — | — |
| Velivet Triphasic Regimen Desogestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| CEFEPIME HYDROCHLORIDE AND DEXTROSE CEFEPIME HYDROCHLORIDE | — Medicare Part D | — | — | — |
| MetroCream metronidazole | — Medicare Part D | — | — | — |
| ELFABRIO pegunigalsidase alfa | — Medicare Part D | — | — | — |
| FENOFIBRIC ACID DELAYED-RELEASE FENOFIBRIC ACID | — Medicare Part D | — | — | — |
| FABIOR tazarotene | — Medicare Part D | — | — | — |
| Buspirone HCL Buspirone HCL | — Medicare Part D | — | — | — |
| DAXXIFY botulinum toxin type A | — Medicare Part D | — | — | — |
| WAYRILZ rilzabrutinib | — Medicare Part D | — | — | — |
| AMLODIPINE BESYLATE 2.5 mg, AMLODIPINE BESYLATE 5 mg, AMLODIPINE BESYLATE 10 mg | — Medicare Part D | — | — | — |
| Irinotecan Hydrochloride Irinotecan Hydrochloride | — Medicare Part D | — | — | — |
| SOTALOL HYDROCHLORIDE Sotalol Hydrochloride | — Medicare Part D | — | — | — |
| AQNEURSA levacetylleucine | — Medicare Part D | Yes | — | — |
| Captopril Captopril | — Medicare Part D | — | — | — |
| Fluphenazine Hydrochloride fluphenazine hydrochloride | — Medicare Part D | — | — | — |
| Tilia Fe NdAc and EE Tablets and Ferrous Fumarate Tablets | — Medicare Part D | — | — | — |
| Horizant gabapentin enacarbil | — Medicare Part D | — | — | — |
| Cladribine Cladribine | — Medicare Part D | — | — | — |