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 |
|---|---|---|---|---|
| DIMETHYL FUMARATE Dimethyl fumarate | — Medicare Part D | — | — | — |
| Carbon Dioxide Compressed Carbon Dioxide | — Medicare Part D | — | — | — |
| NuvaRing etonogestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| MYCOPHENOLIC ACID Mycophenolic Acid | — Medicare Part D | — | — | — |
| ELYXYB - celecoxib celecoxib | — Medicare Part D | — | — | — |
| RISEDRONATE SODIUM Risedronate Sodium | — Medicare Part D | — | — | — |
| Qfitlia fitusiran | — Medicare Part D | — | — | — |
| Qlosi Pilocarpine Hydrochloride | — Medicare Part D | — | — | — |
| Tydemy Drospirenone, Ethinyl Estradiol and Levomefolate Calcium and Levomefolate Calcium | — Medicare Part D | — | — | — |
| Adalimumab-ryvk adalimumab-ryvk | — Medicare Part D | — | — | — |
| Strattera Atomoxetine hydrochloride | — Medicare Part D | — | — | — |
| Onivyde IRINOTECAN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| LIBTAYO cemiplimab-rwlc | — Medicare Part D | — | — | — |
| BRIELLYN Norethindrone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Meclofenamate Sodium meclofenamate sodium | — Medicare Part D | — | — | — |
| Promethazine Promethazine Hydrochloride | — Medicare Part D | — | — | — |
| Quinidine Gluconate Quinidine Gluconate | — Medicare Part D | — | — | — |
| NIFEDIPINE Nifedipine | — Medicare Part D | — | — | — |
| NAROPIN ropivacaine hydrochloride | — Medicare Part D | — | — | — |
| Anectine Succinylcholine Chloride | — Medicare Part D | — | — | — |
| Anusol HC hydrocortisone | — Medicare Part D | — | — | — |
| Septaforce Baptisia Tinctoria, Echinacea (Angustifolia), Arsenicum Album, Chininum Sulphuricum, Crotalus Horridus, Lachesis Mutus, Secale Cornutum, Tarentula Cubensis, Latrodectus Mactans, Anthracinum, Loxosceles Reclusa | — Medicare Part D | — | — | — |
| Heparin Sodium in Dextrose Heparin Sodium and Dextrose | — Medicare Part D | — | — | — |
| Clindamycin in 5 Percent Dextrose Clindamycin in 5 Percent Dextrose | — Medicare Part D | — | — | — |
| Mysoline Primidone | — Medicare Part D | — | — | — |
| Korsuva difelikefalin | — Medicare Part D | — | — | — |
| Medorrhinum GONORRHEAL URETHRAL SECRETION HUMAN | — Medicare Part D | — | — | — |
| Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals | — Medicare Part D | — | — | — |
| VALPROIC ACID Valproic Acid | — Medicare Part D | — | — | — |
| Zegalogue dasiglucagon | — Medicare Part D | Yes | — | — |
| JAVYGTOR Sapropterin Dihydrochloride | — Medicare Part D | — | — | — |
| CARBIDOPA AND LEVODOPA Carbidopa and Levodopa | — Medicare Part D | — | — | — |
| OXYCODONE HYDROCHLORIDE OXYCODONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| ganciclovir sodium ganciclovir sodium | — Medicare Part D | — | — | — |
| OXYCODONE HYDROCHLORIDE OXYCODONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Sertraline HCL Sertraline | — Medicare Part D | — | — | — |
| Neostigmine neostigmine methylsulfate | — Medicare Part D | — | — | — |
| APLISOL Tuberculin Purified Protein Derivative | — Medicare Part D | — | — | — |
| Pramosone hydrocortisone acetate and pramoxine hydrochloride | — Medicare Part D | — | — | — |
| Texacort Hydrocortisone | — Medicare Part D | — | — | — |
| FENOPROFEN CALCIUM FENOPROFEN CALCIUM | — Medicare Part D | — | — | — |
| Pramosone Cream hydrocortisone acetate and pramoxine hydrochloride | — Medicare Part D | — | — | — |
| LYNOZYFIC linvoseltamab-gcpt | — Medicare Part D | — | — | — |
| Diethylpropion Hydrochloride DIETHYLPROPION HYDROCHLORIDE | — Medicare Part D | — | — | — |
| DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE, DEXTROAMPHETAMINE SULFATE, AND AMPHETAMINE SULFATE Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate | — Medicare Part D | — | — | — |
| Generlac Lactulose | — Medicare Part D | — | — | — |
| Reveos Select CPD with AS-5 Red Cell Preservative Solution For Collection Of 500ml Of Blood | — Medicare Part D | — | — | — |
| Penicillamine Penicillamine | — Medicare Part D | — | — | — |
| Loargys pegzilarginase-nbln | — Medicare Part D | — | — | — |
| Tamsulosin Hydrochloride Tamsulosin Hydrochloride | — Medicare Part D | — | — | — |