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 |
|---|---|---|---|---|
| NP Thyroid 15 LEVOTHYROXINE, LIOTHYRONINE | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 8% Sulfur 4% CLEANSER Sodium Sulfacetamide and Sulfur | — Medicare Part D | — | — | — |
| Meprobamate Meprobamate | — Medicare Part D | — | — | — |
| Chorionic Gonadotropin Chorionic Gonadotropin | — Medicare Part D | — | — | — |
| Phesgo pertuzumab, trastuzumab, and hyaluronidase-zzxf | — Medicare Part D | — | — | — |
| MOTEGRITY PRUCALOPRIDE | — Medicare Part D | — | — | — |
| Mono-Linyah norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Fosfomycin Tromethamine Fosfomycin Tromethamine | — Medicare Part D | — | — | — |
| Pentamidine Isethionate PENTAMIDINE ISETHIONATE | — Medicare Part D | — | — | — |
| XIFAXAN rifaximin | — Medicare Part D | — | — | — |
| Hemgenix etranacogene dezaparvovec | — Medicare Part D | — | — | — |
| LMR Plus Lidocaine | — Medicare Part D | — | — | — |
| ZINC SULFATE Zinc Sulfate Injection | — Medicare Part D | — | — | — |
| Tocilizumab-anoh tocilizumab | — Medicare Part D | Yes | — | — |
| PCXX PEPPERMINT NEUTRAL GL Sodium Fluoride | — Medicare Part D | — | — | — |
| Desmopressin Acetate Desmopressin Acetate | — Medicare Part D | — | — | — |
| Timolol Maleate Timolol Maleate Ophthalmic | — Medicare Part D | — | — | — |
| Gastrocrom cromolyn sodium | — Medicare Part D | — | — | — |
| SOLU-MEDROL methylprednisolone sodium succinate | — Medicare Part D | — | — | — |
| Orgovyx relugolix | — Medicare Part D | — | — | — |
| Desipramine HCL DESIPRAMINE HCl | — Medicare Part D | — | — | — |
| Rowasa mesalamine | — Medicare Part D | — | — | — |
| Oxycodone and Aspirin Oxycodone and Aspirin | — Medicare Part D | — | — | — |
| Ertapenem Ertapenem Sodium | — Medicare Part D | — | — | — |
| Sodium Tetradecyl Sulfate SODIUM TETRADECYL SULFATE | — Medicare Part D | — | — | — |
| DIFFERIN Adapalene | — Medicare Part D | — | — | — |
| METRONIDAZOLE Metronidazole | — Medicare Part D | — | — | — |
| LINCOMYCIN Lincomycin Hydrochloride | — Medicare Part D | — | — | — |
| Midazolam Midazolam | — Medicare Part D | — | — | — |
| PYLERA BISMUTH SUBCITRATE POTASSIUM, METRONIDAZOLE, and TETRACYCLINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Plasma-Lyte 148 (pH 7.4) Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride, Magnesium Chloride | — Medicare Part D | — | — | — |
| Polocaine-MPF, Polocaine | — Medicare Part D | — | — | — |
| Nabi-HB Hepatitis B Immune Globulin (Human) | — Medicare Part D | — | — | — |
| THALLOUS CHLORIDE Tl 201 thallous chloride, Tl 201 | — Medicare Part D | — | — | — |
| Glatopa Glatiramer Acetate | — Medicare Part D | — | — | — |
| Travasol Leucine, Phenylalanine, Lysine hydrochloride, Methionine, Isoleucine, Valine, Histidine, Threonine, Tryptophan, Alanine, Glycine, Arginine, Proline, Tyrosine, Serine | — Medicare Part D | Yes | — | — |
| INVANZ ertapenem sodium | — Medicare Part D | — | — | — |
| Lidocaine Viscous Lidocaine Hydrochloride | — Medicare Part D | — | — | — |
| Naloxone Hydrochloride Injection, USP, Auto-Injector | — Medicare Part D | — | — | — |
| Sensorcaine MPF BUPIVACAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Xylocaine XYLOCAINE | — Medicare Part D | — | — | — |
| Gemcitabine hydrochloride Gemcitabine Hydrochloride | — Medicare Part D | — | — | — |
| LIPIODOL ethiodized oil | — Medicare Part D | — | — | — |
| Exelderm Sulconazole Nitrate | — Medicare Part D | — | — | — |
| Tretinoin Tretinoin | — Medicare Part D | — | — | — |
| Brimonidine Tartrate/Timolol Maleate Ophthalmic Solution Brimonidine Tartrate and Timolol Maleate | — Medicare Part D | — | — | — |
| Ery Erythromycin | — Medicare Part D | — | — | — |
| Akovaz ephedrine sulfate | — Medicare Part D | — | — | — |
| clobetasol propionate emollient formulation clobetasol propionate | — Medicare Part D | — | — | — |
| Armodafinil armodafinil | — Medicare Part D | — | — | — |