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 |
|---|---|---|---|---|
| Skytrofa Lonapegsomatropin-tcgd | — Medicare Part D | — | — | — |
| CEFDINIR Cefdinir | — Medicare Part D | — | — | — |
| GLYCOPYRROLATE 1ML Glycopyrrolate | — Medicare Part D | — | — | — |
| Pitavastatin Calcium pitavastatin | — Medicare Part D | — | — | — |
| PredniSONE Tablets, USP, 5 mg, PredniSONE Tablets, USP, 10 mg, PredniSONE Tablets, USP, 20 mg | — Medicare Part D | — | — | — |
| toremifene citrate toremifene citrate | — Medicare Part D | — | — | — |
| Lidotral 5 Percent and Hydrocortisone 1 Percent with Peptides and Arnica Lidocaine HCl 5 % , Hydrocortisone Acetate 1% | — Medicare Part D | — | — | — |
| Ephedrine Sulfate Ephedrine Sulfate | — Medicare Part D | — | — | — |
| Clonidine transdermal system clonidine transdermal system | — Medicare Part D | — | — | — |
| PYRIDOXINE HCI PYRIDOXINE HCI | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 9.8% and Sulfur 4.8% Cleanser SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| Fulvestrant Fulvestrant | — Medicare Part D | — | — | — |
| Miglustat miglustat | — Medicare Part D | — | — | — |
| Phenytoin Infatabs Phenytoin | — Medicare Part D | — | — | — |
| MODEYSO dordaviprone | — Medicare Part D | — | — | — |
| Stelara, STELARA | — Medicare Part D | Yes | — | — |
| SINGULAIR montelukast sodium | — Medicare Part D | — | — | — |
| CEVIMELINE cevimeline hydrochloride | — Medicare Part D | — | — | — |
| estrogens, conjugated ESTROGENS, CONJUGATED | — Medicare Part D | — | — | — |
| ARANESP darbepoetin alfa | — Medicare Part D | Yes | — | — |
| Cilostazol Cilostazol | — Medicare Part D | — | — | — |
| Atropine Atropine Sulfate | — Medicare Part D | — | — | — |
| Clindamycin Phosphate Clindamycin Phosphate | — Medicare Part D | — | — | — |
| KEYTRUDA pembrolizumab | — Medicare Part D | — | — | — |
| Danazol Danazol | — Medicare Part D | — | — | — |
| Dactinomycin DACTINOMYCIN | — Medicare Part D | — | — | — |
| HYMPAVZI marstacimab-hncq | — Medicare Part D | — | — | — |
| BRUKINSA zanubrutinib | — Medicare Part D | — | — | — |
| Doxepin Hydrochloride doxepin hydrochloride | — Medicare Part D | — | — | — |
| DOPamine Hydrochloride Dopamine Hydrochloride | — Medicare Part D | — | — | — |
| DIVIGEL estradiol | — Medicare Part D | — | — | — |
| MARCAINE WITH EPINEPHRINE BUPIVACAINE HYDROCHLORIDE AND EPINEPHRINE | — Medicare Part D | — | — | — |
| Amcinonide Amcinonide | — Medicare Part D | — | — | — |
| Nestabs ONE Vitamin C, Vitamin D, Vitamin E, Vitamin B6, Folate, Vitamin B12, Iron, Zinc, Magnesium, DHA | — Medicare Part D | — | — | — |
| Eptifibatide Eptifibatide | — Medicare Part D | — | — | — |
| Lisinopril Lisinopril | — Medicare Part D | — | — | — |
| MiCort HC Cream Hydrocortisone Acetate Cream | — Medicare Part D | — | — | — |
| Nitrofurantoin Monohydrate/Macrocrystal Nitrofurantoin Monohydrate/Macrocrystal | — Medicare Part D | — | — | — |
| LOFENA DICLOFENAC POTASSIUM | — Medicare Part D | — | — | — |
| Prazosin Hydrochloride Prazosin Hydrochloride | — Medicare Part D | — | — | — |
| Xofigo Radium Ra 223 dichloride | — Medicare Part D | — | — | — |
| Norditropin somatropin | — Medicare Part D | Yes | — | — |
| TRIHEXYPHENIDYL HYDROCHLORIDE Trihexyphenidyl Hydrochloride | — Medicare Part D | — | — | — |
| almotriptan Almotriptan | — Medicare Part D | — | — | — |
| PROPAFENONE HYDROCHLORIDE Propafenone Hydrochloride | — Medicare Part D | — | — | — |
| Cyproheptadine Hydrochloride Cyproheptadine Hydrochloride | — Medicare Part D | — | — | — |
| Vybrique sildenafil citrate | — Medicare Part D | — | — | — |
| Lidocaine HCl - Hydrocortisone Acetate with Aloe Lidocaine HCl and Hydrocortisone Acetate | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE (XL) Bupropion hydrochloride | — Medicare Part D | — | — | — |
| Gentamicin Sulfate in Sodium Chloride Gentamicin Sulfate | — Medicare Part D | — | — | — |