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 |
|---|---|---|---|---|
| Potassium Chloride in Lactated Ringers and Dextrose POTASSIUM CHLORIDE, SODIUM CHLORIDE, CALCIUM CHLORIDE, SODIUM LACTATE, and DEXTROSE MONOHYDRATE | — Medicare Part D | — | — | — |
| LMD in Dextrose, LMD in Sodium Chloride | — Medicare Part D | — | — | — |
| GloStrips Fluorescein Sodium | — Medicare Part D | — | — | — |
| NADOLOL Nadolol | — Medicare Part D | — | — | — |
| Acyclovir acyclovir | — Medicare Part D | — | — | — |
| Urso 250, Urso Forte | — Medicare Part D | — | — | — |
| Metformin Hydrochloride Oral Solution metformin hydrochloride | — Medicare Part D | — | — | — |
| GLYBURIDE Glyburide | — Medicare Part D | — | — | — |
| TruGuard 5000 Sodium Fluoride Toothpaste | — Medicare Part D | — | — | — |
| ALBUTEROL SULFATE ALBUTEROL SULFATE | — Medicare Part D | — | — | — |
| Joyeaux Levonorgestrel and Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| Haloperidol haloperidol | — Medicare Part D | — | — | — |
| Chlorpromazine Hydrochloride Chlorpromazine Hydrochloride | — Medicare Part D | — | — | — |
| ProHance gadoteridol | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE (SR) Bupropion hydrochloride | — Medicare Part D | — | — | — |
| LASIX ONYU furosemide | — Medicare Part D | — | — | — |
| FASLODEX Fulvestrant | — Medicare Part D | — | — | — |
| VIORELE Desogestrel and Ethinyl Estradiol and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Sacubitril and Valsartan Sacubitril and Valsartan | — Medicare Part D | — | — | — |
| Alfuzosin Hydrochloride Alfuzosin Hydrochloride | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 9% and Sulfur 4.5% Wash | — Medicare Part D | — | — | — |
| Norgesic Orphenadrine Citrate, Aspirin and Caffeine | — Medicare Part D | — | — | — |
| Orenitram treprostinil | — Medicare Part D | — | — | — |
| Icosapent Ethyl icosapent ethyl | — Medicare Part D | — | — | — |
| ESBRIET PIRFENIDONE | — Medicare Part D | — | — | — |
| Air, Compressed Nitrogen, Oxygen | — Medicare Part D | — | — | — |
| Nitroglycerin Transdermal Infusion System Nitroglycerin | — Medicare Part D | — | — | — |
| Elzonris tagraxofusp | — Medicare Part D | — | — | — |
| Cefotan Cefotetan | — Medicare Part D | — | — | — |
| Fluticasone Propionate and Salmeterol Fluticasone Propionate and Salmeterol | — Medicare Part D | — | — | — |
| Theo-24 theophylline anhydrous | — Medicare Part D | — | — | — |
| IMITREX sumatriptan | — Medicare Part D | — | — | — |
| Sumatriptan Succinate and Naproxen Sodium Sumatriptan Succinate and Naproxen Sodium | — Medicare Part D | — | — | — |
| VIVIMUSTA BENDAMUSTINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Nesina alogliptin | — Medicare Part D | — | — | — |
| Linezolid Linezolid | — Medicare Part D | — | — | — |
| Physicians EZ Use B-12 Compliance Physicians EZ Use B-12 Compliance | — Medicare Part D | — | — | — |
| Plexion SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| Bacteriostatic Sodium Chloride SODIUM CHLORIDE | — Medicare Part D | — | — | — |
| Zolmitriptan Zolmitriptan | — Medicare Part D | — | — | — |
| levalbuterol inhalation levalbuterol inhalation 1.25mg/3mL | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 38/62 Oxygen/Nitrogen 38/62 | — Medicare Part D | — | — | — |
| Ritonavir Ritonavir | — Medicare Part D | — | — | — |
| Exforge amlodipine valsartan and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Norgestimate and Ethinyl Estradiol Norgestimate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Zanosar Streptozocin | — Medicare Part D | — | — | — |
| LETROZOLE Letrozole | — Medicare Part D | — | — | — |
| Endari Glutamine | — Medicare Part D | — | — | — |
| Acetaminophen Acetaminophen | — Medicare Part D | — | — | — |
| STEGLATRO ertugliflozin | — Medicare Part D | — | — | — |