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 |
|---|---|---|---|---|
| Lenalidomide Lenalidomide | — Medicare Part D | — | — | — |
| Lactulose Solution Lactulose | — Medicare Part D | — | — | — |
| TRESIBA insulin degludec | — Medicare Part D | Yes | — | — |
| Myoview Tetrofosmin | — Medicare Part D | — | — | — |
| Diclofenac Sodium and Misoprostol Diclofenac Sodium and Misoprostol | — Medicare Part D | — | — | — |
| FAVLYXA Fluorouracil | — Medicare Part D | — | — | — |
| Isosorbide Isosorbide Dinitrate | — Medicare Part D | — | — | — |
| Lamotrigine Lamotrigine | — Medicare Part D | — | — | — |
| LEMTRADA ALEMTUZUMAB | — Medicare Part D | — | — | — |
| ALBUTEROL SULFATE ALBUTEROL SULFATE | — Medicare Part D | — | — | — |
| Tropicamide Tropicamide | — Medicare Part D | — | — | — |
| Cyltezo adalimumab-adbm | — Medicare Part D | — | — | — |
| PRIMAXIN IV imipenem and cilastatin sodium | — Medicare Part D | — | — | — |
| CLOBAZAM Clobazam | — Medicare Part D | — | — | — |
| Giapreza angiotensin II | — Medicare Part D | — | — | — |
| TEZRULY Terazosin | — Medicare Part D | — | — | — |
| BEVESPI AEROSPHERE Glycopyrrolate and formoterol fumarate | — Medicare Part D | — | — | — |
| Divalproex Sodium D/R Divalproex Sodium D/R | — Medicare Part D | — | — | — |
| DONEPEZIL HYDROCHLORIDE Donepezil Hydrochloride | — Medicare Part D | — | — | — |
| FAMCICLOVIR Famciclovir | — Medicare Part D | — | — | — |
| Folartex Multivitamin | — Medicare Part D | — | — | — |
| PREGABALIN Pregabalin | — Medicare Part D | — | — | — |
| Telmisartan telmisartan | — Medicare Part D | — | — | — |
| TACLONEX calcipotriene and betamethasone dipropionate | — Medicare Part D | — | — | — |
| ARTICAINE Articaine Hydrochloride and Epinephrine | — Medicare Part D | — | — | — |
| lumicain Aluminium Chloride Hexahydrate | — Medicare Part D | — | — | — |
| DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE, DEXTROAMPHETAMINE SULFATE, AND AMPHETAMINE SULFATE Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate | — Medicare Part D | — | — | — |
| TRANEXAMIC ACID IN SODIUM CHLORIDE TRANEXAMIC ACID | — Medicare Part D | — | — | — |
| RECOTHROM thrombin topical recombinant | — Medicare Part D | — | — | — |
| BICILLIN CR penicillin G benzathine and penicillin G procaine | — Medicare Part D | Yes | — | — |
| SIMVASTATIN Simvastatin | — Medicare Part D | — | — | — |
| BETAMETHASONE VALERATE Betamethasone Valerate | — Medicare Part D | — | — | — |
| KETOCONAZOLE Ketoconazole | — Medicare Part D | — | — | — |
| ULORIC febuxostat | — Medicare Part D | — | — | — |
| Bisoprolol Bisoprolol fumarate | — Medicare Part D | — | — | — |
| CleanCare Chlorhexidine Gluconate 0.12% Oral Rinse | — Medicare Part D | — | — | — |
| DOXYCYCLINE HYCLATE DELAYED RELEASE doxycycline hyclate | — Medicare Part D | — | — | — |
| Evkeeza evinacumab | — Medicare Part D | — | — | — |
| LEXETTE halobetasol propionate | — Medicare Part D | — | — | — |
| LISINOPRIL AND HYDROCHLOROTHIAZIDE Lisinopril and Hydrochlorothiazide Tablets | — Medicare Part D | — | — | — |
| Flagyl metronidazole | — Medicare Part D | — | — | — |
| Lidothol lidocaine and menthol | — Medicare Part D | — | — | — |
| NYSTATIN AND TRIAMCINOLONE ACETONIDE nystatin and triamcinolone acetonide | — Medicare Part D | — | — | — |
| Amoxicillin Amoxicillin | — Medicare Part D | — | — | — |
| Protonix I.V. pantoprazole sodium | — Medicare Part D | — | — | — |
| ACCOLATE Zafirlukast | — Medicare Part D | — | — | — |
| Treprostinil Treprostinil | — Medicare Part D | — | — | — |
| Diclofenac sodium and Misoprostol DR Diclofenac sodium and Misoprostol | — Medicare Part D | — | — | — |
| MUTAMYCIN Mitomycin | — Medicare Part D | — | — | — |
| STIFF JOINTS HP Bryonia Alba Root, Colchicum Autumnale Bulb, Kalmia Latifolia Leaf, Ledum Palustre Twig, Lycopodium Clavatum Spore, Rhododendron Aureum Leaf, Toxicodendron Pubescens Leaf | — Medicare Part D | — | — | — |