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 |
|---|---|---|---|---|
| MONTELUKAST Montelukast | — Medicare Part D | — | — | — |
| Selarsdi ustekinumab-aekn | — Medicare Part D | — | — | — |
| AZATHIOPRINE AZATHIOPRINE | — Medicare Part D | — | — | — |
| Prolensa Bromfenac Sodium | — Medicare Part D | — | — | — |
| Sodium Citrate 4% w/v Anticoagulant TRISODIUM CITRATE DIHYDRATE | — Medicare Part D | — | — | — |
| neomycin sulfate, polymyxin b sulfate and dexamethasone neomycin sulfate, polymyxin b sulfate and dexamethasone | — Medicare Part D | — | — | — |
| Tetrabenazine Tetrabenazine | — Medicare Part D | — | — | — |
| Aricept donepezil hydrochloride | — Medicare Part D | — | — | — |
| BICILLIN L-A penicillin G benzathine | — Medicare Part D | Yes | — | — |
| Epaned enalapril maleate | — Medicare Part D | — | — | — |
| Adzenys XR-ODT Amphetamine | — Medicare Part D | — | — | — |
| NEMLUVIO nemolizumab-ilto | — Medicare Part D | Yes | — | — |
| Rabeprazole Sodium Rabeprazole Sodium | — Medicare Part D | — | — | — |
| Elitek rasburicase | — Medicare Part D | — | — | — |
| Physicians EZ Use M-pred Methylprednisolone Acetate, Bupivacaine Hydrochloride, Povidone-Iodine | — Medicare Part D | — | — | — |
| AMIDATE(TM) ETOMIDATE | — Medicare Part D | — | — | — |
| DICLOFENAC SODIUM diclofenac sodium | — Medicare Part D | — | — | — |
| PRENATE Restore ascorbic acid, cholecalciferol, .alpha.-tocopherol acetate, dl-, folic acid, pyridoxine hydrochloride, cyanocobalamin, biotin, calcium carbonate, ferrous fumarate, magnesium oxide, lactic acid and doconexent | — Medicare Part D | — | — | — |
| Neostigmine Methylsulfate neostigmine methylsulfate | — Medicare Part D | — | — | — |
| Bupivacaine HCl BUPIVACAINE HCl | — Medicare Part D | — | — | — |
| Diclofenac Sodium Topical Solution diclofenac sodium | — Medicare Part D | — | — | — |
| CAFFEINE CITRATE caffeine citrate | — Medicare Part D | — | — | — |
| Lidocaine 5% Gel Lidocaine 5% | — Medicare Part D | — | — | — |
| OZURDEX dexamethasone | — Medicare Part D | — | — | — |
| Microgestin Fe 1/20 Norethindrone Acetate/Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| RADICAVA, RADICAVA ORS | — Medicare Part D | Yes | — | — |
| Vraylar cariprazine | — Medicare Part D | — | — | — |
| Lextol Diclofenac Sodium, Capsaicin | — Medicare Part D | — | — | — |
| DULOXETINE HYDROCHLORIDE DULOXETINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Vitamin C 10 % L-Ascorbic Acid | — Medicare Part D | — | — | — |
| TRIAMCINOLONE ACETONIDE Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| Gliadel carmustine | — Medicare Part D | — | — | — |
| Terbinafine Terbinafine Hydrochloride | — Medicare Part D | — | — | — |
| Aminocaproic Acid aminocaproic acid | — Medicare Part D | — | — | — |
| VOWST fecal microbiota spores, live-brpk | — Medicare Part D | Yes | — | — |
| NITROFURANTOIN NITROFURANTOIN | — Medicare Part D | — | — | — |
| Deferiprone deferiprone | — Medicare Part D | — | — | — |
| Neostigmine Methylsulfate neostigmine methylsulfate | — Medicare Part D | — | — | — |
| Carbinoxamine Maleate Extended-Release Oral Suspension Carbinoxamine Maleate | — Medicare Part D | — | — | — |
| Diclofenac DR Diclofenac | — Medicare Part D | — | — | — |
| DULOXETINE Duloxetine | — Medicare Part D | — | — | — |
| SODIUM SULFACETAMIDE, SULFUR sodium sulfacetamide, sulfur | — Medicare Part D | — | — | — |
| DULOXETINE Duloxetine | — Medicare Part D | — | — | — |
| TRYVIO TRYVIO | — Medicare Part D | — | — | — |
| Isosorbide dinitrate and hydralazine hydrochloride isosorbide dinitrate and hydralazine hydrochloride | — Medicare Part D | — | — | — |
| IMATINIB MESYLATE imatinib mesylate | — Medicare Part D | — | — | — |
| FINGOLIMOD fingolimod hydrochloride | — Medicare Part D | — | — | — |
| Doxazosin Doxazosin Mesylate | — Medicare Part D | — | — | — |
| NORETHINDRONE ACETATE AND ETHINYL ESTRADIOL norethindrone acetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Folixate Folate, Vitamin D3 | — Medicare Part D | — | — | — |