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 |
|---|---|---|---|---|
| Ambien zolpidem tartrate | — Medicare Part D | — | — | — |
| Fluticasone Furoate and Vilanterol fluticasone furoate and vilanterol | — Medicare Part D | — | — | — |
| CHLORZOXAZONE CHLORZOXAZONE | — Medicare Part D | — | — | — |
| CLOTRIMAZOLE AND BETAMETHASONE DIPROPIONATE Clotrimazole and Betamethasone Dipropionate | — Medicare Part D | — | — | — |
| phenylephrine hydrochloride injection, solution Phenylephrine Hydrochloride | — Medicare Part D | — | — | — |
| DIMETHYL FUMARATE Dimethyl fumarate | — Medicare Part D | — | — | — |
| Otulfi ustekinumab-aauz | — Medicare Part D | — | — | — |
| Capecitabine Capecitabine | — Medicare Part D | — | — | — |
| GABAPENTIN gabapentin | — Medicare Part D | — | — | — |
| Iclevia Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| CAFFEINE CITRATE caffeine citrate | — Medicare Part D | — | — | — |
| Selenium Sulfide SELENIUM SULFIDE | — Medicare Part D | — | — | — |
| OXTELLAR XR OXCARBAZEPINE | — Medicare Part D | — | — | — |
| Vitafol-OB Plus DHA Prenatal Supplement Plus DHA Vitamin A, Ascorbic Acid, Vitamin D, .Alpha.-Tocopherol, Thiamine Mononitrate, Riboflavin, Niacin, Pyridoxine Hydrochloride, Folic Acid, Cyanocobalamin, Calcium, Iron, Magnesium, Zinc, Copper, and Doconexent | — Medicare Part D | — | — | — |
| Protamine Sulfate PROTAMINE SULFATE | — Medicare Part D | — | — | — |
| Chlorhexidine Gluconate chlorhexidine gluconate | — Medicare Part D | — | — | — |
| PREGABALIN Pregabalin | — Medicare Part D | — | — | — |
| QELBREE viloxazine hydrochloride | — Medicare Part D | — | — | — |
| Lidogel Lidocaine HCl | — Medicare Part D | — | — | — |
| AHZANTIVE aflibercept-mrbb | — Medicare Part D | — | — | — |
| BRIMONIDINE TARTRATE and TIMOLOL MALEATE Brimonidine Tartrate and Timolol Maleate | — Medicare Part D | — | — | — |
| Plegisol POTASSIUM CHLORIDE, SODIUM CHLORIDE, CALCIUM CHLORIDE, and MAGNESIUM CHLORIDE | — Medicare Part D | — | — | — |
| Opium Tincture Deodorized morphine tincture | — Medicare Part D | — | — | — |
| Amnesteem isotretinoin | — Medicare Part D | — | — | — |
| Readi-Cat 2 Berry Smoothie, Readi-Cat 2 Banana Smoothie, Readi-Cat 2, Readi-Cat 2 Creamy Vanilla Smoothie, Readi-Cat 2 Mochaccino Smoothie | — Medicare Part D | — | — | — |
| Dilantin Extended Phenytoin Sodium | — Medicare Part D | — | — | — |
| LIDOCAINE HCI AND DEXTROSE LIDOCAINE HCI AND DEXTROSE | — Medicare Part D | — | — | — |
| AZSTARYS Serdexmethylphenidate and Dexmethylphenidate | — Medicare Part D | — | — | — |
| PCXX VANILLA ORANGE NEUTRAL GL Sodium Fluoride | — Medicare Part D | — | — | — |
| EnilloRing Etonogestrel and Ethinyl Estradiol Vaginal | — Medicare Part D | — | — | — |
| AZITHROMYCIN, AZITHROMYCIN DIHYDRATE | — Medicare Part D | — | — | — |
| BETAMETHASONE VALERATE Betamethasone Valerate | — Medicare Part D | — | — | — |
| METOPROLOL SUCCINATE Metoprolol succinate | — Medicare Part D | — | — | — |
| BENZPHETAMINE HYDROCHLORIDE Benzphetamine Hydrochloride | — Medicare Part D | — | — | — |
| SYMFI Efavirenz, Lamivudine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| Chlorhexidine Gluconate Oral Rinse | — Medicare Part D | — | — | — |
| Disopyramide Phosphate DISOPYRAMIDE PHOSPHATE | — Medicare Part D | — | — | — |
| Ravicti glycerol phenylbutyrate | — Medicare Part D | — | — | — |
| SUPREP Bowel Prep sodium sulfate, potassium sulfate, magnesium sulfate | — Medicare Part D | — | — | — |
| PRIALT ziconotide acetate | — Medicare Part D | — | — | — |
| RANITIDINE Ranitidine | — Medicare Part D | — | — | — |
| LAGEVRIO molnupiravir | — Medicare Part D | — | — | — |
| Neomycin and Polymyxin B Sulfates and Bacitracin Zinc Neomycin sulfate, Polymyxin B Sulfate and Bacitracin Zinc | — Medicare Part D | — | — | — |
| Syzygium jambolanum Syzygium Jambolanum, Glandula Suprarenalis Suis, Hydrastis Canadensis, Hypophysis Suis, Pancreas Suis, Phaseolus, Aceticum Acidum, Lacticum Acidum, Phosphoricum Acidum, Phosphorus, Uranium Nitricum | — Medicare Part D | — | — | — |
| PROCHLORPERAZINE MALEATE Prochlorperazine Maleate | — Medicare Part D | — | — | — |
| Doxycycline Monohydrate Doxycycline Monohydrate | — Medicare Part D | — | — | — |
| Spironolactone Spironolactone | — Medicare Part D | — | — | — |
| NICARDIPINE HYDROCHLORIDE Nicardipine Hydrochloride | — Medicare Part D | — | — | — |
| Rozerem ramelteon | — Medicare Part D | — | — | — |
| GaviLyte - C TM polyethylene glycol-3350 and electrolytes with Flavor Pack | — Medicare Part D | — | — | — |