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 |
|---|---|---|---|---|
| Xiclo diclofenac | — Medicare Part D | — | — | — |
| Loteprednol etabonate and Tobramycin Loteprednol etabonate and Tobramycin | — Medicare Part D | — | — | — |
| Metyrosine Metyrosine | — Medicare Part D | — | — | — |
| BUPIVICAINE HYDROCHLORIDE BUPIVICAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| GALLIUM CITRATE GA-67 gallium citrate ga-67 | — Medicare Part D | — | — | — |
| Alimta Pemetrexed disodium | — Medicare Part D | — | — | — |
| FLUTICASONE PROPIONATE FLUTICASONE PROPIONATE | — Medicare Part D | — | — | — |
| PERCOCET oxycodone hydrochloride and acetaminophen | — Medicare Part D | — | — | — |
| COMPRESSED Gas OXIDIZING, N.O.S. OXYGEN, HELIUM | — Medicare Part D | — | — | — |
| Idarubicin Hydrochloride Idarubicin Hydrochloride | — Medicare Part D | — | — | — |
| NIFEDIPINE Nifedipine | — Medicare Part D | — | — | — |
| omeprazole sodium bicarbonate Omeprazole, sodium bicarbonate | — Medicare Part D | — | — | — |
| Imipramine Pamoate Imipramine Pamoate | — Medicare Part D | — | — | — |
| Xerese Acyclovir and Hydrocortisone | — Medicare Part D | — | — | — |
| TOBRAMYCIN AND DEXAMETHASONE Tobramycin and dexamethasone | — Medicare Part D | — | — | — |
| Pirfenidone Pirfenidone | — Medicare Part D | — | — | — |
| Nystatin Oral Suspension NYSTATIN | — Medicare Part D | — | — | — |
| Migranow sumatriptan succinate, camphor, menthol | — Medicare Part D | — | — | — |
| Contepo fosfomycin disodium | — Medicare Part D | — | — | — |
| UPLIZNA Inebilizumab | — Medicare Part D | — | — | — |
| Diclona Gel Lidocaine 4.5%, Diclofenac 1% | — Medicare Part D | — | — | — |
| Abilify MyCite ARIPIPRAZOLE | — Medicare Part D | — | — | — |
| ADAPALENE AND BENZOYL PEROXIDE adapalene and benzoyl peroxide topical | — Medicare Part D | — | — | — |
| Nipent PENTOSTATIN | — Medicare Part D | — | — | — |
| Varibar Thin Honey barium sulfate | — Medicare Part D | — | — | — |
| Helium, Oxygen Helium/Oxygen Mixture 80/20 | — Medicare Part D | — | — | — |
| SAXAGLIPTIN SAXAGLIPTIN | — Medicare Part D | — | — | — |
| Primaquine Phosphate Primaquine Phosphate | — Medicare Part D | — | — | — |
| Doxorubicin Hydrochloride Liposome Doxorubicin Hydrochloride | — Medicare Part D | — | — | — |
| Zydelig idelalisib | — Medicare Part D | — | — | — |
| Ergocalciferol Capsules, ergocalciferol | — Medicare Part D | — | — | — |
| Elinest Norgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Dulcamara Bryonia, Dulcamara, Kali Carb, Sanguinaria, Belladonna, Bromium, Candida Alb, Candida Parap, Conium, Lycopodium, Pulsatilla, Secale, Silicea, Sticta, Sulphur, Ustilago Maidis | — Medicare Part D | — | — | — |
| Coreg Carvedilol | — Medicare Part D | — | — | — |
| SYMDEKO Tezacaftor and Ivacaftor | — Medicare Part D | Yes | — | — |
| Cleocin Pediatric clindamycin palmitate hydrochloride | — Medicare Part D | — | — | — |
| Hemady dexamethasone | — Medicare Part D | — | — | — |
| BILDYOS Denosumab | — Medicare Part D | Yes | — | — |
| Linzess linaclotide | — Medicare Part D | — | — | — |
| ONGENTYS opicapone | — Medicare Part D | — | — | — |
| PIFELTRO doravirine | — Medicare Part D | — | — | — |
| Gemcitabine Gemcitabine | — Medicare Part D | — | — | — |
| Rectiv nitroglycerin | — Medicare Part D | — | — | — |
| SUPRANE DESFLURANE | — Medicare Part D | — | — | — |
| Acular Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| METHADONE HYDROCHLORIDE Methadone Hydrochloride | — Medicare Part D | — | — | — |
| Sodium Fluoride 1.1% Dental Gel BUBBLEGUM | — Medicare Part D | — | — | — |
| CLEMSZA Clemastine Fumarate | — Medicare Part D | — | — | — |
| Teriflunomide Teriflunomide | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide Wash 10% | — Medicare Part D | — | — | — |