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 |
|---|---|---|---|---|
| COARTEM Coartem | — Medicare Part D | — | — | — |
| FLUOROURACIL FLUOROURACIL | — Medicare Part D | — | — | — |
| Amantadine Amantadine Hydrochloride | — Medicare Part D | — | — | — |
| Premarin Vaginal conjugated estrogens | — Medicare Part D | — | — | — |
| Oxygen Nitrogen Mixture Oxygen Nitrogen Mixture | — Medicare Part D | — | — | — |
| XIFYRM meloxicam | — Medicare Part D | — | — | — |
| LAMIVUDINE lamivudine | — Medicare Part D | — | — | — |
| Collavera Collavera | — Medicare Part D | — | — | — |
| KENALOG-10 TRIAMCINOLONE ACETONIDE | — Medicare Part D | — | — | — |
| Heliox Heliox | — Medicare Part D | — | — | — |
| Vimpat lacosamide | — Medicare Part D | — | — | — |
| Intelence etravirine | — Medicare Part D | — | — | — |
| ERTAPENEM SODIUM Ertapenem Sodium | — Medicare Part D | — | — | — |
| Sodium Chloride Sodium Chloride | — Medicare Part D | — | — | — |
| BAVENCIO avelumab | — Medicare Part D | — | — | — |
| Indapamide Indapamide | — Medicare Part D | — | — | — |
| Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| Aubra EQ Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Drax Exametazime Kit for the Preparation of Technetium Tc 99m Exametazime for Leukocyte Labeling | — Medicare Part D | — | — | — |
| Tri-Linyah Norgestimate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Kanjinti trastuzumab-anns | — Medicare Part D | — | — | — |
| DMT SUIK Dexamethasone Sodium Phosphate | — Medicare Part D | — | — | — |
| Minocycline Hydrochloride minocycline hydrochloride | — Medicare Part D | — | — | — |
| HEPARIN SODIUM IN SODIUM CHLORIDE HEPARIN SODIUM | — Medicare Part D | — | — | — |
| Lidotral Five Percent Lidocaine Hydrochloride | — Medicare Part D | — | — | — |
| Oxacillin Oxacillin Sodium | — Medicare Part D | — | — | — |
| Pregnyl CHORIOGONADOTROPIN ALFA | — Medicare Part D | — | — | — |
| Pentam 300 PENTAMIDINE ISETHIONATE | — Medicare Part D | — | — | — |
| YUPELRI revefenacin | — Medicare Part D | — | — | — |
| TADALAFIL Tadalafil | — Medicare Part D | — | — | — |
| Necon norethindrone and ethinyl estradiol | — Medicare Part D | — | — | — |
| .Insulin Aspart Protamine and Insulin Aspart insulin aspart | — Medicare Part D | — | — | — |
| Calcipotriene and Betamethasone Dipropionate Calcipotriene, Betamethasone Dipropionate | — Medicare Part D | — | — | — |
| Neuraceq Florbetaben F 18 | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 75/25 Oxygen/Nitrogen 75/25 | — Medicare Part D | — | — | — |
| Kidney Drainage Solidago Virgaurea, Asparagus Officinalis, Juniperus Communis, Sabal Serrulata, Uva-Ursi, Berberis Vulgaris, Equisetum Arvense, Urtica Dioica, Rubia Tinctorum, Staphysagria, Cantharis, Fagus Sylvatica, Flos, Glandula Suprarenalis Suis, Hepar Sulphuris Calcareum, Kidney (Suis), Larix Decidua, Flos, Manganum Metallicum, Mimulus Guttatus, Flos, Nitricum Acidum, Rhus Aromatica, Silicea, Ulex Europaeus, Flos, Benzoicum Acidum, Cobaltum Metallicum | — Medicare Part D | — | — | — |
| Disopyramide Phosphate DISOPYRAMIDE PHOSPHATE | — Medicare Part D | — | — | — |
| FENTANYL Fentanyl Citrate | — Medicare Part D | — | — | — |
| OPDIVO QVANTIG nivolumab and hyaluronidase-nvhy | — Medicare Part D | — | — | — |
| BENAZEPRIL HYDROCHLORIDE Benazepril Hydrochloride | — Medicare Part D | — | — | — |
| ATMEKSI methocarbamol | — Medicare Part D | — | — | — |
| 6% HETASTARCH IN 0.9% SODIUM CHLORIDE 6% HETASTARCH IN 0.9% SODIUM CHLORIDE | — Medicare Part D | — | — | — |
| Cyclogyl cyclopentolate hydrochloride | — Medicare Part D | — | — | — |
| Ganirelix Acetate Ganirelix Acetate | — Medicare Part D | — | — | — |
| POTASSIUM CHLORIDE IN DEXTROSE Potassium Chloride and Dextrose Monohydrate | — Medicare Part D | — | — | — |
| Testosterone Gel, 1% | — Medicare Part D | — | — | — |
| Venofer iron sucrose | — Medicare Part D | — | — | — |
| DOBUTAMINE HYDROCHLORIDE DOBUTAMINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| VIRACEPT nelfinavir mesylate | — Medicare Part D | — | — | — |
| ESTERIFIED ESTROGENS AND METHYLTESTOSTERONE ESTERIFIED ESTROGENS, METHYLTESTOSTERONE | — Medicare Part D | — | — | — |