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 |
|---|---|---|---|---|
| Midazolam Midazolam | — Medicare Part D | — | — | — |
| Rasuvo methotrexate | — Medicare Part D | — | — | — |
| OGIVRI trastuzumab-dkst | — Medicare Part D | — | — | — |
| Marlido Kit marcaine, lidocaine, povidone iodine | — Medicare Part D | — | — | — |
| Orbactiv oritavancin | — Medicare Part D | — | — | — |
| Clozapine Clozapine | — Medicare Part D | — | — | — |
| Hydrocortisone Butyrate Hydrocortisone butyrate | — Medicare Part D | — | — | — |
| Pyridium Phenazopyridine | — Medicare Part D | — | — | — |
| GLIPIZIDE ER glipizide | — Medicare Part D | — | — | — |
| XACIATO clindamycin phosphate | — Medicare Part D | — | — | — |
| PANCREAZE PANCRELIPASE LIPASE, PANCRELIPASE AMYLASE, and PANCRELIPASE PROTEASE | — Medicare Part D | — | — | — |
| POLIVY polatuzumab vedotin | — Medicare Part D | — | — | — |
| Telmisartan telmisartan | — Medicare Part D | — | — | — |
| Potassium Chloride POTASSIUM CHLORIDE | — Medicare Part D | — | — | — |
| Premarin estrogens, conjugated | — Medicare Part D | — | — | — |
| CINACALCET Cinacalcet | — Medicare Part D | — | — | — |
| APREPITANT Aprepitant | — Medicare Part D | — | — | — |
| Katerzia Amlodipine | — Medicare Part D | — | — | — |
| GRAFCO APPLICATOR 15 CM Silver Nitrate | — Medicare Part D | — | — | — |
| TICAGRELOR Ticagrelor | — Medicare Part D | — | — | — |
| KENGREAL cangrelor | — Medicare Part D | — | — | — |
| Fluphenazine Decanoate Fluphenazine Decanoate | — Medicare Part D | — | — | — |
| Hysingla ER hydrocodone bitartrate | — Medicare Part D | — | — | — |
| HYDRALAZINE HYDROCHLORIDE Hydralazine Hydrochloride | — Medicare Part D | — | — | — |
| Fabrazyme AGALSIDASE BETA | — Medicare Part D | — | — | — |
| PENCICLOVIR Penciclovir | — Medicare Part D | — | — | — |
| Efavirenz, Emtricitabine And Tenofovir Disoproxil Fumarate Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| Lutera levonorgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| Rivastigmine rivastigmine | — Medicare Part D | — | — | — |
| MLK F4 Kit Triamcinolone Acetonide, Lidocaine Hydrochloride, Bupivacaine Hydrochloride, Povidine Iodine | — Medicare Part D | — | — | — |
| Mono-Linyah norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |
| HYRNUO SEVABERTINIB | — Medicare Part D | — | — | — |
| SAXAGLIPTIN SAXAGLIPTIN | — Medicare Part D | — | — | — |
| Rufinamide rufinamide | — Medicare Part D | — | — | — |
| Acunol Nickel Sulfate, Potassium Bromide, Sodium Bromide, Zinc Sulfate Anhydrous, and Sulfur | — Medicare Part D | — | — | — |
| Tri-Estarylla norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Omega-3-Acid Ethyl Esters OMEGA-3-ACID ETHYL ESTERS | — Medicare Part D | — | — | — |
| Phenohytro Phenobarbital, Hyoscyamine Sulfate, Atropine sulfate, and Scopolamine Hydrobromide | — Medicare Part D | — | — | — |
| METADATE CD methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Rabeprazole Sodium DR Rabeprazole Sodium | — Medicare Part D | — | — | — |
| Campath ALEMTUZUMAB | — Medicare Part D | — | — | — |
| Butalbital, Acetaminophen, Caffeine and Codeine Phosphate Butalbital, Acetaminophen, Caffeine and Codeine Phosphate | — Medicare Part D | — | — | — |
| Valacyclovir Hydrochloride Valacyclovir Hydrochloride | — Medicare Part D | — | — | — |
| Jevtana cabazitaxel | — Medicare Part D | — | — | — |
| Memantine Hydrochloride Memantine Hydrochloride | — Medicare Part D | — | — | — |
| Truxima rituximab-abbs | — Medicare Part D | — | — | — |
| Sertraline HCL Sertraline | — Medicare Part D | — | — | — |
| CEFPROZIL Cefprozil | — Medicare Part D | — | — | — |
| FENTANYL CITRATE Fentanyl Citrate | — Medicare Part D | — | — | — |
| Gleevec imatinib mesylate | — Medicare Part D | — | — | — |