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 |
|---|---|---|---|---|
| KAPSPARGO Metoprolol Succinate | — Medicare Part D | — | — | — |
| Drospirenone/Ethinyl Estradiol/Levomefolate Calcium and Levomefolate Calcium Drospirenone/ethinyl estradiol/levomefolate calcium and levomefolate calcium | — Medicare Part D | — | — | — |
| Prednisone prednisone | — Medicare Part D | — | — | — |
| Hydrocortisone and Acetic Acid Hydrocortisone and Acetic Acid | — Medicare Part D | — | — | — |
| Norethindrone and ethinyl estradiol norethindrone and ethinyl estradiol | — Medicare Part D | — | — | — |
| Nucala mepolizumab | — Medicare Part D | Yes | — | — |
| SILDENAFIL CITRATE SILDENAFIL CITRATE | — Medicare Part D | — | — | — |
| Sodium Chloride Sodium Chloride | — Medicare Part D | — | — | — |
| BISMUTH SUBCITRATE POTASSIUM, METRONIDAZOLE, AND TETRACYCLINE HYDROCHLORIDE BISMUTH SUBCITRATE POTASSIUM, METRONIDAZOLE, and TETRACYCLINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| SODIUM SULFATE, POTASSIUM SULFATE AND MAGNESIUM SULFATE Sodium Sulfate, Potassium Sulfate and Magnesium Sulfate | — Medicare Part D | — | — | — |
| TESTOSTERONE CYPIONATE Testosterone Cypionate | — Medicare Part D | — | — | — |
| OSELTAMIVIR Oseltamivir | — Medicare Part D | — | — | — |
| Scopolamine scopolamine | — Medicare Part D | — | — | — |
| Tymlos abaloparatide | — Medicare Part D | Yes | — | — |
| PALONOSETRON Palonosetron Hydrochloride | — Medicare Part D | — | — | — |
| BETAMETHASONE DIPROPIONATE Betamethasone dipropionate | — Medicare Part D | — | — | — |
| Monoferric Ferric derisomaltose | — Medicare Part D | — | — | — |
| Nelarabine Nelarabine | — Medicare Part D | — | — | — |
| Lidocan V Lidocaine 5% | — Medicare Part D | — | — | — |
| LACTATED RINGERS AND DEXTROSE SODIUM CHLORIDE, SODIUM LACTATE, POTASSIUM CHLORIDE, CALCIUM CHLORIDE, and DEXTROSE MONOHYDRATE | — Medicare Part D | — | — | — |
| NuvaRing etonogestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| AMIODARONE HYDROCHLORIDE Amiodarone hydrochloride | — Medicare Part D | — | — | — |
| CLINIMIX E Leucine, Phenylalanine, Lysine, Methionine, Isoleucine, Valine, Histidine, Threonine, Tryptophan, Alanine, Glycine, Arginine, Proline, Serine, Tyrosine, Sodium Acetate, Dibasic Potassium Phosphate, Magnesium Chloride, Sodium Chloride, Calcium Chloride, Dextrose | — Medicare Part D | Yes | — | — |
| Vecuronium Bromide VECURONIUM BROMIDE | — Medicare Part D | — | — | — |
| Dobutamine Hydrochloride in Dextrose Dobutamine Hydrochloride | — Medicare Part D | — | — | — |
| Hydralazine Hydralazine Hydrochloride | — Medicare Part D | — | — | — |
| Aviane Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Etodolac Etodolac | — Medicare Part D | — | — | — |
| PEMRYDI RTU Pemetrexed disodium | — Medicare Part D | — | — | — |
| Acyclovir acyclovir | — Medicare Part D | — | — | — |
| Fesoterodine Fumarate FESOTERODINE FUMARATE | — Medicare Part D | — | — | — |
| FluoriMax 5000 1.1% Sodium Fluoride Toothpaste | — Medicare Part D | — | — | — |
| Clonazepam Clonazepam | — Medicare Part D | — | — | — |
| Erythromycin Lactobionate Erythromycin Lactobionate | — Medicare Part D | Yes | — | — |
| HALOPERIDOL DECANOATE Haloperidol Decanoate | — Medicare Part D | — | — | — |
| TROGARZO ibalizumab | — Medicare Part D | — | — | — |
| FLOVENT HFA fluticasone propionate | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 10% wash Sodium Sulfacetamide | — Medicare Part D | — | — | — |
| Brimonidine Tartrate ophthalmic solution, 0.15% | — Medicare Part D | — | — | — |
| Lidocan VII Lidocaine 5% | — Medicare Part D | — | — | — |
| Eysuvis loteprednol etabonate | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide Sodium Sulfacetamide | — Medicare Part D | — | — | — |
| Oxaprozin Oxaprozin | — Medicare Part D | — | — | — |
| POMBILITI ATGA cipaglucosidase alfa-atga | — Medicare Part D | — | — | — |
| Vasotec Enalapril Maleate | — Medicare Part D | — | — | — |
| Fentanyl system Fentanyl | — Medicare Part D | — | — | — |
| BKEMV eculizumab-aeeb | — Medicare Part D | — | — | — |
| Tacrolimus Tacrolimus | — Medicare Part D | — | — | — |
| DORZOLAMIDE HYDROCHLORIDE dorzolamide hydrochloride | — Medicare Part D | — | — | — |
| INFLIXIMAB Infliximab | — Medicare Part D | Yes | — | — |