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 |
|---|---|---|---|---|
| Susvimo Ranibizumab | — Medicare Part D | — | — | — |
| Terconazole Vaginal Cream 0.8% | — Medicare Part D | — | — | — |
| TNKase tenecteplase | — Medicare Part D | — | — | — |
| PIROXICAM Piroxicam | — Medicare Part D | — | — | — |
| DEFITELIO defibrotide sodium | — Medicare Part D | — | — | — |
| Adenosine ADENOSINE | — Medicare Part D | — | — | — |
| Treprostinil, DILUENT | — Medicare Part D | Yes | — | — |
| Focalin dexmethylphenidate hydrochloride | — Medicare Part D | — | — | — |
| MAYZENT siponimod | — Medicare Part D | — | — | — |
| Cyclosporine cyclosporine | — Medicare Part D | — | — | — |
| OHM-FLU Anas barbariae, hepatis et cordis extractum, Influenzinum | — Medicare Part D | — | — | — |
| LOPREEZA estradiol/norethindrone acetate | — Medicare Part D | — | — | — |
| Hydrocodone Bitartrate and Ibuprofen Hydrocodone Bitartrate and Ibuprofen | — Medicare Part D | — | — | — |
| AcetaZOLAMIDE acetazolamide | — Medicare Part D | — | — | — |
| ITVISMA onasemnogene abeparvovec-brve | — Medicare Part D | — | — | — |
| Thiothixene Thiothixene | — Medicare Part D | — | — | — |
| VAFSEO Vadadustat | — Medicare Part D | — | — | — |
| Furosemide Furosemide | — Medicare Part D | — | — | — |
| Ala-Scalp Hydrocortisone | — Medicare Part D | — | — | — |
| RETEVMO selpercatinib | — Medicare Part D | — | — | — |
| TAZICEF CEFTAZIDIME | — Medicare Part D | — | — | — |
| JOBEVNE bevacizumab-nwgd | — Medicare Part D | — | — | — |
| QIVIGY kthm human immunoglobulin g | — Medicare Part D | — | — | — |
| Prozac Fluoxetine hydrochloride | — Medicare Part D | — | — | — |
| Methylergonovine Maleate Methylergonovine maleate | — Medicare Part D | — | — | — |
| BENZTROPINE MESYLATE BENZTROPINE MESYLATE | — Medicare Part D | — | — | — |
| Ethamolin Ethanolamine Oleate | — Medicare Part D | — | — | — |
| DECITABINE Decitabine | — Medicare Part D | — | — | — |
| MoviPrep POLYETHYLENE GLYCOL 3350, SODIUM SULFATE, SODIUM CHLORIDE, POTASSIUM CHLORIDE, ASCORBIC ACID, SODIUM ASCORBATE | — Medicare Part D | — | — | — |
| Hydroxyurea HYDROXYUREA | — Medicare Part D | — | — | — |
| VTAMA tapinarof | — Medicare Part D | — | — | — |
| TRICON TRICON | — Medicare Part D | — | — | — |
| Brimonidine Tartrate/Timolol Maleate Brimonidine Tartrate and Timolol Maleate | — Medicare Part D | — | — | — |
| Ampicillin, Ampicillin sodium | — Medicare Part D | — | — | — |
| ZELAPAR SELEGILINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Lumason, LumaSon | — Medicare Part D | — | — | — |
| Matronex Ferrous Fumarate, Folic Acid | — Medicare Part D | — | — | — |
| VITAMIN D ergocalciferol | — Medicare Part D | — | — | — |
| Dapsone 100 mg, Dapsone 25 mg | — Medicare Part D | — | — | — |
| Amoxicillin 500 mg Amoxicillin | — Medicare Part D | — | — | — |
| Foscarnet Sodium foscarnet sodium | — Medicare Part D | — | — | — |
| Alacort Hydrocortisone | — Medicare Part D | — | — | — |
| VELCADE bortezomib | — Medicare Part D | — | — | — |
| METFORMIN HYDROCHLORIDE EXTENDED RELEASE, METFORMIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Ultiva Remifentanil Hydrochloride | — Medicare Part D | — | — | — |
| RIFAMPIN Rifampin | — Medicare Part D | — | — | — |
| Adbry tralokinumab-ldrm | — Medicare Part D | Yes | — | — |
| Pretomanid Pretomanid | — Medicare Part D | — | — | — |
| Sodium Oxybate Sodium Oxybate | — Medicare Part D | — | — | — |
| Methyltestosterone METHYLTESTOSTERONE | — Medicare Part D | — | — | — |