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 |
|---|---|---|---|---|
| Carbamazepine ER Carbamazepine ER | — Medicare Part D | — | — | — |
| ERLEADA Apalutamide | — Medicare Part D | — | — | — |
| Micafungin in Sodium Chloride Micafungin in Sodium Chloride | — Medicare Part D | — | — | — |
| Dexamethasone 1.5 mg Dexamethasone 1.5 mg | — Medicare Part D | — | — | — |
| PYRUKYND mitapivat | — Medicare Part D | — | — | — |
| DOPamine Hydrochloride Dopamine Hydrochloride | — Medicare Part D | — | — | — |
| Enjaymo sutimlimab-jome | — Medicare Part D | — | — | — |
| IRBESARTAN AND HYDROCHLOROTHIAZIDE Irbesartan and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Lantus insulin glargine | — Medicare Part D | — | — | — |
| OSPOMYV denosumab | — Medicare Part D | Yes | — | — |
| PreviDent Alcohol Free Sodium Fluoride | — Medicare Part D | — | — | — |
| Nelarabine Nelarabine | — Medicare Part D | — | — | — |
| XOLAIR, Xolair PFS, Xolair | — Medicare Part D | Yes | — | — |
| Apixaban APIXABAN | — Medicare Part D | — | — | — |
| Docetaxel Docetaxel | — Medicare Part D | — | — | — |
| MIDODRINE HYDROCHLORIDE Midodrine Hydrochloride | — Medicare Part D | — | — | — |
| Tovet (emollient formulation) CLOBETASOL PROPIONATE | — Medicare Part D | — | — | — |
| Avapro irbesartan | — Medicare Part D | — | — | — |
| Mexiletine Hydrochloride Mexiletine hydrochloride | — Medicare Part D | — | — | — |
| ARISTADA aripiprazole lauroxil | — Medicare Part D | Yes | — | — |
| PROMETHAZINE HYDROCHLORIDE Promethazine Hydrochloride | — Medicare Part D | — | — | — |
| Antara fenofibrate | — Medicare Part D | — | — | — |
| Nilandron Nilutamide | — Medicare Part D | — | — | — |
| HYDROMORPHONE HYDROCHLORIDE HYDROMORPHONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Phenoxybenzamine Hydrochloride PHENOXYBENZAMINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Mitosol mitomycin | — Medicare Part D | — | — | — |
| LACTULOSE Lactulose | — Medicare Part D | — | — | — |
| Zingo lidocaine hydrochloride monohydrate | — Medicare Part D | — | — | — |
| Sildenafil Sildenafil | — Medicare Part D | — | — | — |
| EPLERENONE eplerenone | — Medicare Part D | — | — | — |
| HYDRALAZINE HYDROCHLORIDE Hydralazine Hydrochloride | — Medicare Part D | — | — | — |
| APADAZ Benzhydrocodone and Acetaminophen | — Medicare Part D | — | — | — |
| ORPHENGESIC FORTE Orphenadrine Citrate, Aspirin and Caffeine | — Medicare Part D | — | — | — |
| Technetium Tc 99m Medronate technetium tc 99m medronate | — Medicare Part D | — | — | — |
| Tavaborole Tavaborole | — Medicare Part D | — | — | — |
| Prenatrix Ferrous Fumarate, Folic Acid | — Medicare Part D | — | — | — |
| Crotalus horridus Elaps corallinus, Aesculus hipp., Aloe, Arsenicum alb., Bryonia, Calc. fluor., Capsicum, Collinsonia, Crotalus horridus, Hamamelis, Hydrofluoricum acidum, Hypericum, Lachesis, Lycopodium, Millefolium, Naja, Nux vom., Paeonia, Plantago, Quercus glandium spiritus, Ratanhia, Vipera berus, Echinacea, Solidago, Urtica ur. | — Medicare Part D | — | — | — |
| Brivaracetam Oral Solution brivaracetam | — Medicare Part D | — | — | — |
| Budesonide Inhalation budesonide inhalation | — Medicare Part D | — | — | — |
| Granisol granisetron hydrochloride | — Medicare Part D | — | — | — |
| Droxidopa Droxidopa | — Medicare Part D | — | — | — |
| GABAPENTIN gabapentin | — Medicare Part D | — | — | — |
| Falmina levonorgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| INFASURF CALFACTANT | — Medicare Part D | — | — | — |
| Yeztugo LENACAPAVIR SODIUM | — Medicare Part D | — | — | — |
| Tolsura Itraconazole | — Medicare Part D | — | — | — |
| Enbumyst bumetanide | — Medicare Part D | — | — | — |
| BREYNA Budesonide and Formoterol Fumarate | — Medicare Part D | — | — | — |
| LIKMEZ Metronidazole Oral | — Medicare Part D | — | — | — |
| CORTEF hydrocortisone sodium succinate | — Medicare Part D | — | — | — |