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 |
|---|---|---|---|---|
| Xtandi enzalutamide | — Medicare Part D | — | — | — |
| DORZOLAMIDE HYDROCHLORIDE dorzolamide hydrochloride | — Medicare Part D | — | — | — |
| CARBZAH Carbinoxamine Maleate | — Medicare Part D | — | — | — |
| ORLISTAT orlistat | — Medicare Part D | — | — | — |
| Climara Pro Estradiol and Levonorgestrel | — Medicare Part D | — | — | — |
| ROPINIROLE ROPINIROLE | — Medicare Part D | — | — | — |
| emtricitabine, rilpivirine and tenofovir disoproxil fumarate emtricitabine, rilpivirine and tenofovir disoproxil fumarate | — Medicare Part D | — | — | — |
| Dibasic Sodium Phosphate, Monobasic Potassium Phosphate and Monobasic Sodium Phosphate Dibasic Sodium Phosphate, Monobasic Potassium Phosphate and Monobasic Sodium Phosphate | — Medicare Part D | Yes | — | — |
| NEVIRAPINE nevirapine | — Medicare Part D | — | — | — |
| Sensipar cinacalcet hydrochloride | — Medicare Part D | — | — | — |
| Clorazepate Dipotassium Clorazepate Dipotassium | — Medicare Part D | — | — | — |
| BRENZAVVY Bexagliflozin | — Medicare Part D | — | — | — |
| Staphylococcinum STAPHYLOCOCCUS EPIDERMIDIS, STAPHYLOCOCCUS HAEMOLYTICUS, STAPHYLOCOCCUS SIMULANS | — Medicare Part D | — | — | — |
| Brexpiprazole BREXPIPRAZOLE | — Medicare Part D | — | — | — |
| JASCAYD nerandomilast | — Medicare Part D | — | — | — |
| LOREEV XR lorazepam | — Medicare Part D | — | — | — |
| COCAINE HYDROCHLORIDE Cocaine Hydrochloride | — Medicare Part D | — | — | — |
| Lignospan Standard Lidocaine Hydrochloride and Epinephrine | — Medicare Part D | — | — | — |
| RYTELO imetelstat sodium | — Medicare Part D | — | — | — |
| Optiray 320, Optiray 350 | — Medicare Part D | — | — | — |
| Vitramyn Folic Acid | — Medicare Part D | — | — | — |
| BENAZEPRIL HYDROCHLORIDE Benazepril Hydrochloride | — Medicare Part D | — | — | — |
| Loxapine Loxapine | — Medicare Part D | — | — | — |
| Dolishale Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| TRIHEXYPHENIDYL HYDROCHLORIDE Trihexyphenidyl Hydrochloride | — Medicare Part D | — | — | — |
| PYRAZINAMIDE Pyrazinamide | — Medicare Part D | — | — | — |
| BSS PLUS balanced salt solution enriched with bicarbonate, dextrose, and glutathione | — Medicare Part D | — | — | — |
| Arestin Minocycline Hydrochloride | — Medicare Part D | — | — | — |
| FOSAPREPITANT FOSAPREPITANT | — Medicare Part D | — | — | — |
| GLUCAGON Glucagon | — Medicare Part D | Yes | — | — |
| polymyxin b sulfate and trimethoprim sulfate Polymyxin B Sulfate and Trimethoprim Sulfate | — Medicare Part D | — | — | — |
| Antara fenofibrate | — Medicare Part D | — | — | — |
| Naproxen Sodium, Naproxen sodium | — Medicare Part D | — | — | — |
| Hydrocodone Bitartrate and Homatropine Methylbromide Hydrocodone Bitartrate and Homatropine Methylbromide | — Medicare Part D | — | — | — |
| ELMIRON PENTOSAN POLYSULFATE SODIUM | — Medicare Part D | — | — | — |
| Omega-3-Acid Ethyl Ester omega-3-acid ethyl esters | — Medicare Part D | — | — | — |
| VENLAFAXINE HYDROCHLORIDE VENLAFAXINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Vixa Skineal Vixa Skineal Compound ketoconazole | — Medicare Part D | — | — | — |
| Cholestyramine for Oral Suspension Cholestyramine for Oral Suspension | — Medicare Part D | — | — | — |
| LIDODERM Lidocaine Patch 5% | — Medicare Part D | — | — | — |
| Epoprostenol Epoprostenol | — Medicare Part D | — | — | — |
| SAPROPTERIN DIHYDROCHLORIDE sapropterin dihydrochloride | — Medicare Part D | — | — | — |
| Marcaine, Marcaine with Epinephrine | — Medicare Part D | — | — | — |
| Ibuprofen Lysine Ibuprofen Lysine | — Medicare Part D | — | — | — |
| Hydromet hydrocodone bitartrate and homatropine methylbromide | — Medicare Part D | — | — | — |
| Kariva Desogestrel/Ethinyl Estradiol and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Derma-Smoothe/FS fluocinolone acetonide | — Medicare Part D | — | — | — |
| Chlorhexidine Gluconate, 0.12% Oral Rinse Solution | — Medicare Part D | — | — | — |
| Mirabegron Mirabegron | — Medicare Part D | — | — | — |
| Phenylephrine Hydrochloride Phenylephrine Hydrochloride | — Medicare Part D | — | — | — |