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 |
|---|---|---|---|---|
| Erythromycin Ethylsuccinate Erythromycin Ethylsuccinate | — Medicare Part D | — | — | — |
| Esomeprazole DR Esomeprazole DR | — Medicare Part D | — | — | — |
| TRANEXAMIC ACID TRANEXAMIC ACID | — Medicare Part D | — | — | — |
| Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| Sensorcaine BUPIVACAINE HYDROCHLORIDE and EPINEPHRINE BITARTRATE | — Medicare Part D | — | — | — |
| PROPRANOLOL propranolol hydrochloride | — Medicare Part D | — | — | — |
| Halaven eribulin mesylate | — Medicare Part D | — | — | — |
| ROCURONIUM BROMIDE ROCURONIUM BROMIDE | — Medicare Part D | — | — | — |
| DDAVP Desmopressin Acetate | — Medicare Part D | — | — | — |
| Cetrorelix Acetate cetrorelix acetate | — Medicare Part D | — | — | — |
| PROPRANOLOL HYDROCHLORIDE propranolol hydrochloride | — Medicare Part D | — | — | — |
| Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% | — Medicare Part D | — | — | — |
| EXEMESTANE Exemestane | — Medicare Part D | — | — | — |
| Toronova II SUIK Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| North American Coral Snake Antivenin (Equine) Coral Snake (Micrurus Fulvius) Immune Globulin Antivenin (Equine) | — Medicare Part D | — | — | — |
| FLOLAN epoprostenol sodium | — Medicare Part D | — | — | — |
| DATROWAY Datopotamab Deruxtecan | — Medicare Part D | — | — | — |
| REMIFENTANIL HYDROCHLORIDE Remifentanil Hydrochloride | — Medicare Part D | — | — | — |
| ERAXIS anidulafungin | — Medicare Part D | Yes | — | — |
| PROCHLORPERAZINE EDISYLATE Prochlorperazine Edisylate | — Medicare Part D | — | — | — |
| PENCICLOVIR Penciclovir | — Medicare Part D | — | — | — |
| BACLOFEN Baclofen | — Medicare Part D | — | — | — |
| YUVAFEM Estradiol | — Medicare Part D | — | — | — |
| OMEPRAZOLE Omeprazole | — Medicare Part D | — | — | — |
| Lescol XL fluvastatin sodium | — Medicare Part D | — | — | — |
| Hexatrione 2% triamcinolone hexacetonide | — Medicare Part D | — | — | — |
| Zenpep pancrelipase lipase, pancrelipase protease, pancrelipase amylase | — Medicare Part D | — | — | — |
| Azasan Azathioprine | — Medicare Part D | — | — | — |
| NAROPIN ropivacaine hydrochloride | — Medicare Part D | — | — | — |
| Vanos fluocinonide | — Medicare Part D | — | — | — |
| IPRATROPIUM BROMIDE Ipratropium Bromide | — Medicare Part D | — | — | — |
| ZEPZELCA Lurbinectedin | — Medicare Part D | — | — | — |
| CROMOLYN SODIUM Cromolyn Sodium | — Medicare Part D | — | — | — |
| KISQALI ribociclib | — Medicare Part D | — | — | — |
| CHANTIX varenicline tartrate | — Medicare Part D | — | — | — |
| PCXX GRAPE APF G Sodium Fluoride | — Medicare Part D | — | — | — |
| COPIKTRA duvelisib | — Medicare Part D | — | — | — |
| Morphine Sulfate ER Morphine Sulfate | — Medicare Part D | — | — | — |
| CAMZYOS mavacamten | — Medicare Part D | — | — | — |
| FOLIC ACID Folic Acid | — Medicare Part D | — | — | — |
| Omeprazole DR Omeprazole | — Medicare Part D | — | — | — |
| OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE Olmesartan Medoxomil and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Cyred EQ Desogestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| EXEMESTANE Exemestane | — Medicare Part D | — | — | — |
| PRISMASOL BGK2/0, PRISMASOL BGK2/3.5, PRISMASOL BGK4/2.5, PRISMASOL BGK0/2.5, PRISMASOL B22GK4/0, PRISMASOL BK0/0/1.2, PRISMASOL BGK4/0/1.2, PHOXILLUM BK4/2.5, PHOXILLUM B22K4/0 | — Medicare Part D | — | — | — |
| DORZOLAMIDE HYDROCHLORIDE AND TIMOLOL MALEATE Dorzolamide Hydrochloride and Timolol Maleate | — Medicare Part D | — | — | — |
| Chenodal Chenodiol | — Medicare Part D | — | — | — |
| Doxorubicin Hydrochloride DOXORUBICIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Insulin Aspart Protamine and Insulin Aspart Mix 70/30 insulin aspart | — Medicare Part D | Yes | — | — |
| IPRATROPIUM BROMIDE Ipratropium Bromide | — Medicare Part D | — | — | — |