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 |
|---|---|---|---|---|
| Dextrose Magnesium Sulfate Heptahydrate | — Medicare Part D | — | — | — |
| Cambia diclofenac potassium | — Medicare Part D | — | — | — |
| Cosyntropin COSYNTROPIN | — Medicare Part D | — | — | — |
| ESTRATEST H.S., ESTRATEST F.S. | — Medicare Part D | — | — | — |
| Lotensin benazepril hydrochloride | — Medicare Part D | — | — | — |
| SODIUM NITROPRUSSIDE Sodium Nitroprusside | — Medicare Part D | — | — | — |
| Sevoflurane SEVOFLURANE | — Medicare Part D | — | — | — |
| Clinisol Lysine, Leucine, Phenylalanine, Valine, Histidine, Isoleucine, Methionine, Threonine, Tryptophan, Alanine, Arginine, Glycine, Proline, Glutamic Acid, Serine, Aspartic Acid, Tyrosine | — Medicare Part D | Yes | — | — |
| Hydrocortisone Acetate Pramoxine Hcl Hydrocortisone Acetate Pramoxine Hcl | — Medicare Part D | — | — | — |
| Microgestin 24 Fe Norethindrone acetate/Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| E.E.S, E.E.S 400 | — Medicare Part D | — | — | — |
| EMRELIS Telisotuzumab Vedotin | — Medicare Part D | — | — | — |
| NITROGEN NITROGEN | — Medicare Part D | — | — | — |
| CLINDAMYCIN HYDROCHLORIDE Clindamycin Hydrochloride | — Medicare Part D | — | — | — |
| Lixofen Diclofenac Sodium, kinesiology tape | — Medicare Part D | — | — | — |
| EQUETRO Carbamazepine | — Medicare Part D | — | — | — |
| Super Mint Prescription Anticavity Toothpaste | — Medicare Part D | — | — | — |
| Tri-Nymyo Norgestimate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Guanfacine guanfacine | — Medicare Part D | — | — | — |
| Blisovi Fe 1/20 norethindrone acetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Bismuth Subcitrate Potassium, Metronidazole and Tetracycline Hydrochloride Bismuth Subcitrate Potassium, Metronidazole and Tetracycline Hydrochloride | — Medicare Part D | — | — | — |
| LEVONORGESTREL AND ETHINYL ESTRADIOL levonorgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| Spinosad spinosad | — Medicare Part D | — | — | — |
| Fluphenazine Hydrochloride fluphenazine hydrochloride | — Medicare Part D | — | — | — |
| ZO Skin Health Pigment Control Program Plus Hydroquinone Hydroquinone | — Medicare Part D | — | — | — |
| Xenazine tetrabenazine | — Medicare Part D | — | — | — |
| Ketoconazole Cream Ketoconazole | — Medicare Part D | — | — | — |
| NU-DERM BLENDER Skin Lightener and Blending, NU-DERM CLEAR Skin Bleaching and Corrector, NU-DERM SUNFADER Skin Lightener with Sunscreen (SPF 15) PABA FREE | — Medicare Part D | — | — | — |
| VYVGART Hytrulo efgartigimod alfa and hyaluronidase (human recombinant) | — Medicare Part D | Yes | — | — |
| NOURIANZ istradefylline | — Medicare Part D | — | — | — |
| NP THYROID 30 LEVOTHYROXINE, LIOTHYRONINE | — Medicare Part D | — | — | — |
| FILSUVEZ birch triterpenes | — Medicare Part D | — | — | — |
| BYLVAY odevixibat | — Medicare Part D | — | — | — |
| Goniotaire HYPROMELLOSE 2906 (4000 MPA.S) | — Medicare Part D | — | — | — |
| Sojourn Sevoflurane | — Medicare Part D | — | — | — |
| OXAZEPAM Oxazepam | — Medicare Part D | — | — | — |
| Disulfiram Disulfiram | — Medicare Part D | — | — | — |
| Suboxone buprenorphine hydrochloride, naloxone hydrochloride | — Medicare Part D | — | — | — |
| NIPRIDE RTU Sodium Nitroprusside | — Medicare Part D | — | — | — |
| Latanoprost Latanoprost | — Medicare Part D | — | — | — |
| Hetlioz, Hetlioz LQ | — Medicare Part D | Yes | — | — |
| Prenate Elite .beta.-carotene, ascorbic acid, cholecalciferol, .alpha.-tocopherol acetate, dl-, thiamine mononitrate, riboflavin, niacinamide, pyridoxine hydrochloride, folic acid, 5-methyltetrahydrofolic acid, calcium formate, ferrous asparto glycinate, cyanocobalamin, biotin, potassium iodide, magnesium oxide, zinc oxide and cupric oxide | — Medicare Part D | — | — | — |
| BACLOFEN Baclofen | — Medicare Part D | — | — | — |
| METHYLPREDNISOLONE methylprednisolone sodium succinate | — Medicare Part D | — | — | — |
| HEMICLOR chlorthalidone | — Medicare Part D | — | — | — |
| Phentermine Hydrochloride PHENTERMINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| MTL1 Leucoflex Anticoagulant Citrate Phosphate Dextrose Solution with AS-1 | — Medicare Part D | — | — | — |
| Targretin bexarotene | — Medicare Part D | — | — | — |
| Lumavex Multivitamin | — Medicare Part D | — | — | — |
| Edaravone Edaravone | — Medicare Part D | Yes | — | — |