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 |
|---|---|---|---|---|
| ILOPERIDONE Iloperidone | — Medicare Part D | — | — | — |
| prednisolone sodium phosphate ODT prednisolone sodium phosphate | — Medicare Part D | — | — | — |
| RISPERDAL CONSTA risperidone | — Medicare Part D | — | — | — |
| ISOVUE 200, ISOVUE 300, ISOVUE 370, ISOVUE 250 | — Medicare Part D | — | — | — |
| DEXTROAMPHETAMINE SULFATE DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| Flumazenil FLUMAZENIL | — Medicare Part D | — | — | — |
| TRIENTINE HYDROCHLORIDE TRIENTINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| AIRSUPRA Albuterol sulfate and budesonide | — Medicare Part D | — | — | — |
| Oxcarbazepine oxcarbazepine | — Medicare Part D | — | — | — |
| Tetracaine HCL Tetracaine HCL | — Medicare Part D | — | — | — |
| XENOVIEW xenon Xe 129 hyperpolarized | — Medicare Part D | — | — | — |
| Carglumic Acid Carglumic acid | — Medicare Part D | — | — | — |
| ASMANEX Mometasone Furoate | — Medicare Part D | — | — | — |
| Vasostrict Vasopressin | — Medicare Part D | — | — | — |
| Marcaine Spinal Bupivacaine Hydrochloride in Dextrose | — Medicare Part D | — | — | — |
| Cangrelor Cangrelor | — Medicare Part D | — | — | — |
| Pramipexole Dihydrochloride Pramipexole Dihydrochloride | — Medicare Part D | — | — | — |
| Paroxetine Hydrochloride paroxetine hydrochloride | — Medicare Part D | — | — | — |
| Pirnuo Mupirocin | — Medicare Part D | — | — | — |
| MYCOPHENOLIC ACID Mycophenolic Acid | — Medicare Part D | — | — | — |
| ATENOLOL, Atenolol | — Medicare Part D | — | — | — |
| Exjade deferasirox | — Medicare Part D | — | — | — |
| CYPROHEPTADINE Cyproheptadine Hydrochloride | — Medicare Part D | — | — | — |
| ETOMIDATE Etomidate | — Medicare Part D | — | — | — |
| Phenylephrine Hydrochloride Phenylephrine Hydrochloride | — Medicare Part D | — | — | — |
| IMURAN azathioprine | — Medicare Part D | — | — | — |
| OSELTAMIVIR PHOSPHATE Oseltamivir phosphate | — Medicare Part D | — | — | — |
| ZIMHI Naloxone Hydrochloride | — Medicare Part D | — | — | — |
| Latrodectus mactans Anthracinum, Apis Mellifica, Arnica Montana, Calendula Officinalis, Conium Maculatum, Echinacea (Angustifolia), Euphorbia Pilulifera, Grindelia, Histaminum Hydrochloricum, Hypericum Perforatum, Lachesis Mutus, Latrodectus Mactans, Ledum Palustre, Pyrogenium, Tarentula Cubensis | — Medicare Part D | — | — | — |
| Chlorpromazine Hydrochloride Chlorpromazine Hydrochloride | — Medicare Part D | — | — | — |
| Fluvoxamine Maleate Fluvoxamine Maleate | — Medicare Part D | — | — | — |
| Timoptic Timolol Maleate | — Medicare Part D | — | — | — |
| TRAMADOL HCL ER, TRAMADOL HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Prenatal Vitamins Plus Low Iron prenatal with ferrous fumarate and folic acid | — Medicare Part D | — | — | — |
| EPSOLAY Benzoyl Peroxide | — Medicare Part D | — | — | — |
| Naratriptan Naratriptan | — Medicare Part D | — | — | — |
| HYDROCORTISONE ACETATE Hydrocortisone Acetate | — Medicare Part D | — | — | — |
| NITROGEN NITROGEN | — Medicare Part D | — | — | — |
| Annovera segesterone acetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE, DEXTROAMPHETAMINE SULFATE, AND AMPHETAMINE SULFATE Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate | — Medicare Part D | — | — | — |
| Cisatracurium Besylate Cisatracurium besylate | — Medicare Part D | — | — | — |
| Idacio adalimumab-aacf | — Medicare Part D | Yes | — | — |
| Fluticasone Propionate and Salmeterol HFA fluticasone propionate and salmeterol xinafoate | — Medicare Part D | — | — | — |
| Adrenalinum Apis Mellifica, Citrus Vulgaris, Clematis Vitalba, Flos, Glandula Suprarenalis (Bovine), Helianthemum Nummularium, Flos, Impatiens Glandulifera, Flos, Kali Phosphoricum, Ornithogalum Umbellatum, Flos, Prunus Cerasifera, Flos, Scutellaria Lateriflora, Viburnum Opulus, Cortisone Aceticum, Aconitum Napellus, Adrenalinum, Dopamine (Hydrochloride) | — Medicare Part D | — | — | — |
| Nuvessa metronidazole | — Medicare Part D | — | — | — |
| Zubsolv buprenorphine hydrochloride and naloxone hydrochloride | — Medicare Part D | — | — | — |
| Carbon Dioxide Air Mixture Carbon Dioxide Air Mixture | — Medicare Part D | — | — | — |
| Lipofen fenofibrate | — Medicare Part D | — | — | — |
| triamterene, Triamterene | — Medicare Part D | — | — | — |
| ZITUVIO Sitagliptin | — Medicare Part D | — | — | — |