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 |
|---|---|---|---|---|
| Flumazenil FLUMAZENIL | — Medicare Part D | — | — | — |
| METOCLOPRAMIDE hydrochloride Metoclopramide Hydrochloride | — Medicare Part D | — | — | — |
| Kisunla donanemab-azbt | — Medicare Part D | — | — | — |
| Vecuronium Bromide VECURONIUM BROMIDE | — Medicare Part D | — | — | — |
| Ciprofloxacin in Dextrose ciprofloxacin | — Medicare Part D | — | — | — |
| Bilprevda Denosumab | — Medicare Part D | Yes | — | — |
| Lincocin lincomycin hydrochloride | — Medicare Part D | — | — | — |
| Memantine memantine hydrochloride and donepezil hydrochloride | — Medicare Part D | — | — | — |
| SETLAKIN Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Triloan II SUIK Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| Synthroid Levothyroxine Sodium | — Medicare Part D | — | — | — |
| Lidexa Lidexa | — Medicare Part D | — | — | — |
| DICLOFENAC POTASSIUM DICLOFENAC POTASSIUM | — Medicare Part D | — | — | — |
| Lunsumio Mosunetuzumab | — Medicare Part D | — | — | — |
| Sterile Cord Blood Collection Unit (MSC127D) Sterile Cord Blood Collection Unit | — Medicare Part D | — | — | — |
| Estradiol Gel ESTRADIOL | — Medicare Part D | — | — | — |
| Aurovela Fe 1/20 Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| ARGATROBAN Argatroban | — Medicare Part D | — | — | — |
| Chemet succimer | — Medicare Part D | — | — | — |
| Relistor Methylnaltrexone bromide | — Medicare Part D | Yes | — | — |
| Livita Children Folate, Multivitamin | — Medicare Part D | — | — | — |
| BISOPROLOL FUMARATE Bisoprolol Fumarate | — Medicare Part D | — | — | — |
| Detectnet copper Cu 64 Dotatate | — Medicare Part D | — | — | — |
| VARDENAFIL VARDENAFIL HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Citalopram citalopram | — Medicare Part D | — | — | — |
| ZYFLO zileuton | — Medicare Part D | — | — | — |
| Striverdi Respimat olodaterol respimat inhalation spray | — Medicare Part D | — | — | — |
| INFANT 4.2% SODIUM BICARBONATE INFANT 4.2% SODIUM BICARBONATE | — Medicare Part D | — | — | — |
| Reclast zoledronic acid | — Medicare Part D | — | — | — |
| Salicor triethanolamine salicylate | — Medicare Part D | — | — | — |
| Lithium Carbonate ER Lithium Carbonate | — Medicare Part D | — | — | — |
| HEPARIN SODIUM IN SODIUM CHLORIDE HEPARIN SODIUM | — Medicare Part D | — | — | — |
| Anagrelide Anagrelide | — Medicare Part D | — | — | — |
| KYGEVVI doxecitine and doxribtimine | — Medicare Part D | — | — | — |
| Omalizumab-igec | — Medicare Part D | Yes | — | — |
| Hydrocortisone Acetate Pramoxine Hcl Hydrocortisone Acetate Pramoxine Hcl | — Medicare Part D | — | — | — |
| VESIcare solifenacin succinate | — Medicare Part D | — | — | — |
| Hyosyne Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| Alhemo concizumab | — Medicare Part D | — | — | — |
| Multitol-M Multivitamin, Folate | — Medicare Part D | — | — | — |
| Methylphenidate methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Thiola tiopronin | — Medicare Part D | — | — | — |
| Oxygen, OXYGEN | — Medicare Part D | — | — | — |
| HERNEXEOS zongertinib | — Medicare Part D | — | — | — |
| OMEPRAZOLE Omeprazole | — Medicare Part D | — | — | — |
| Gemcitabine Gemcitabine | — Medicare Part D | — | — | — |
| SSD Silver Sulfadiazine | — Medicare Part D | — | — | — |
| Zolmitriptan OD Zolmitriptan | — Medicare Part D | — | — | — |
| Norelgestromin and Ethinly Estradiol Norelgestromin and Ethinly Estradiol | — Medicare Part D | — | — | — |
| Rasagiline mesylate rasagiline mesylate | — Medicare Part D | — | — | — |