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 |
|---|---|---|---|---|
| Pertussinum Anthracinum, Arsenicum album, Botulinum, Calcarea hypophosphorosa, Coxiella burnetii, Dysentery bacillus, Francisella tularensis, Gaertner bacillus, Kali sulphuricum, Lac caninum, Malaria officinalis, Mutabile bacillus, Pertussinum, Pestinum, Pyrogenium, Typhoid fever, | — Medicare Part D | — | — | — |
| Dialyvite with Zinc Ascorbic Acid, Thiamine, Riboflavin, Niacinamide, Pyridoxine, Folic Acid, Cobalamin, Biotin, Pantothenic Acid, Zinc | — Medicare Part D | — | — | — |
| DOCTORS CHOICE STANOUS FLUORIDE | — Medicare Part D | — | — | — |
| LURASIDONE HYDROCHLORIDE LURASIDONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Truvada emtricitabine and tenofovir disoproxil fumarate | — Medicare Part D | — | — | — |
| Myobloc rimabotulinumtoxinB | — Medicare Part D | — | — | — |
| Daybue, Daybue Stix | — Medicare Part D | Yes | — | — |
| BETHKIS tobramycin | — Medicare Part D | — | — | — |
| ASPIRIN AND EXTENDED-RELEASE DIPYRIDAMOLE Aspirin and Extended-Release Dipyridamole | — Medicare Part D | — | — | — |
| TRANEXAMIC ACID IN SODIUM CHLORIDE TRANEXAMIC ACID | — Medicare Part D | — | — | — |
| Xalkori CRIZOTINIB | — Medicare Part D | — | — | — |
| Winlevi Clascoterone | — Medicare Part D | — | — | — |
| Revlimid Lenalidomide | — Medicare Part D | — | — | — |
| Lovenox enoxaparin sodium | — Medicare Part D | — | — | — |
| PAXIL paroxetine hydrochloride | — Medicare Part D | — | — | — |
| Motofen difenoxin and atropine sulfate | — Medicare Part D | — | — | — |
| PIPERACILLIN AND TAZOBACTAM Piperacillin and Tazobactam | — Medicare Part D | — | — | — |
| Chloramphenicol Sodium Succinate CHLORAMPHENICOL SODIUM SUCCINATE | — Medicare Part D | — | — | — |
| Osmitrol Mannitol | — Medicare Part D | — | — | — |
| TRANEXAMIC ACID TRANEXAMIC ACID | — Medicare Part D | — | — | — |
| Gen7T Plus Lidocaine, Menthol | — Medicare Part D | — | — | — |
| METHYLPHENIDATE HYDROCHLORIDE methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Lyrica CR PREGABALIN | — Medicare Part D | — | — | — |
| Calcium Gluconate Calcium Gluconate | — Medicare Part D | — | — | — |
| Cysto-Conray II Iothalamate meglumine | — Medicare Part D | — | — | — |
| Purified Cortrophin Gel Repository Corticotropin | — Medicare Part D | — | — | — |
| Dasetta 1/35 Norethindrone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Amiloride Hydrochloride amiloride hydrochloride | — Medicare Part D | — | — | — |
| Buspirone Hydrochloride buspirone hydrochloride | — Medicare Part D | — | — | — |
| Chimaphila umbellata aldesleukin - barium carbonate - chaste tree - chimaphila umbellata - clematis vitalba - conium maculatum flowering top - delphinium staphisagria seed - digitalis - ferric picrate - human interleukin-10 (nonglycosylated) - interferon gamma-1b - melatonin - saw palmetto - selenium - sus scrofa prostate - thuja occidentalis twig - transforming growth factor beta-1 - zinc - | — Medicare Part D | — | — | — |
| Envarsus XR Tacrolimus | — Medicare Part D | — | — | — |
| FOSAMAX alendronate sodium | — Medicare Part D | — | — | — |
| Brimonidine Tartrate brimonidine tartrate | — Medicare Part D | — | — | — |
| Mycozyl HC Tolnaftate, Hydrocortisone | — Medicare Part D | — | — | — |
| Methylene Blue Methylene Blue | — Medicare Part D | — | — | — |
| Vabrinty Leuprolide acetate | — Medicare Part D | — | — | — |
| Mercaptopurine Mercaptopurine | — Medicare Part D | — | — | — |
| CERVIDIL DINOPROSTONE | — Medicare Part D | — | — | — |
| Topiramate Topiramate | — Medicare Part D | — | — | — |
| Butalbital, Acetaminophen, Caffeine Butalbital, Acetaminophen, and Caffeine | — Medicare Part D | — | — | — |
| DIURIL CHLOROTHIAZIDE | — Medicare Part D | — | — | — |
| Doxazosin Doxazosin Mesylate | — Medicare Part D | — | — | — |
| Brivaracetam Oral Solution brivaracetam | — Medicare Part D | — | — | — |
| RESTORIL temazepam | — Medicare Part D | — | — | — |
| Pemetrexed PEMETREXED DISODIUM | — Medicare Part D | — | — | — |
| Methylin Methylphenidate Hydrochloride | — Medicare Part D | — | — | — |
| Clobex Clobetasol Propionate | — Medicare Part D | — | — | — |
| VIGABATRIN vigabatrin | — Medicare Part D | — | — | — |
| Vyfemla norethindrone and ethinyl estradiol | — Medicare Part D | — | — | — |
| Aurovela 1/20 Norethindrone Acetate and Ethinyl Estradiol | — Medicare Part D | — | — | — |