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 |
|---|---|---|---|---|
| Colchicine Colchicine | — Medicare Part D | — | — | — |
| FAMOTIDINE FAMOTIDINE | — Medicare Part D | — | — | — |
| Lapatinib lapatinib | — Medicare Part D | — | — | — |
| DONEPEZIL HYDROCHLORIDE Donepezil Hydrochloride | — Medicare Part D | — | — | — |
| Diovan HCT valsartan and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Estradiol / Norethindrone Acetate estradiol/norethindrone acetate | — Medicare Part D | — | — | — |
| DICLOFENAC POTASSIUM DICLOFENAC POTASSIUM | — Medicare Part D | — | — | — |
| Yutrepia treprostinil | — Medicare Part D | — | — | — |
| Dextrose and Electrolyte No. 48 Sodium Lactate, Potassium Chloride, Magnesium Chloride, Monobasic Potassium Phosphate, Sodium Chloride and Dextrose monohydrate | — Medicare Part D | — | — | — |
| Hyoscyamine Sulfate Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 9% and Sulfur 4% Cleanser SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| FEMLYV Norethindrone Acetate/Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Oxygen Refrigerated Liquid Oxygen Refrigerated Liquid | — Medicare Part D | — | — | — |
| CEFAZOLIN Cefazolin | — Medicare Part D | — | — | — |
| Nafcillin Nafcillin | — Medicare Part D | — | — | — |
| METHITEST METHYLTESTOSTERONE | — Medicare Part D | — | — | — |
| Livita Adults Folate, Multivitamin | — Medicare Part D | — | — | — |
| Zyprexa, ZYPREXA Zydis, ZYPREXA Intramuscular | — Medicare Part D | Yes | — | — |
| Prednisolone Sodium Phosphate prednisoLONE sodium phosphate | — Medicare Part D | — | — | — |
| Omvoh mirikizumab-mrkz | — Medicare Part D | Yes | — | — |
| OHM Parasites Chenopodium Anthelminticum, Cina, Cucurbita, Pepo, Cuprum Oxydatum Nigrum, Filix Mas, Granatum, Kousso, Ratanhia, Santoninum, Sabadilla, Spigelia, Teucrium Marum. | — Medicare Part D | — | — | — |
| Valcyte valganciclovir | — Medicare Part D | — | — | — |
| Fosfomycin Tromethamine Fosfomycin Tromethamine | — Medicare Part D | — | — | — |
| Atazanavir Sulfate Atazanavir Sulfate | — Medicare Part D | — | — | — |
| OFLOXACIN OTIC Ofloxacin | — Medicare Part D | — | — | — |
| Colchicine Colchicine | — Medicare Part D | — | — | — |
| Ibuprofen, IBUPROFEN | — Medicare Part D | — | — | — |
| Mexiletine Hydrochloride Mexiletine hydrochloride | — Medicare Part D | — | — | — |
| SULFADIAZINE sulfADIAZINE | — Medicare Part D | — | — | — |
| Lopinavir and Ritonavir Lopinavir and Ritonavir | — Medicare Part D | — | — | — |
| Hydroxyzine Hydrochloride Hydroxyzine hydrochloride | — Medicare Part D | — | — | — |
| BUPIVACAINE HYDROCHLORIDE, 0.25% BUPIVACAINE HCl | — Medicare Part D | — | — | — |
| Efavirenz, Emtricitabine And Tenofovir Disoproxil Fumarate Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| TECFIDERA, Tecfidera | — Medicare Part D | — | — | — |
| LEVOLEUCOVORIN CALCIUM Levoleucovorin Calcium | — Medicare Part D | — | — | — |
| Ammonia N 13 Ammonia N 13 | — Medicare Part D | — | — | — |
| HADLIMA adalimumab-bwwd | — Medicare Part D | — | — | — |
| DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE | — Medicare Part D | — | — | — |
| Kalliga Desogestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Seysara sarecycline hydrochloride | — Medicare Part D | — | — | — |
| Viagra sildenafil citrate | — Medicare Part D | — | — | — |
| DEXMEDETOMIDINE HYDROCHLORIDE dexmedetomidine hydrochloride | — Medicare Part D | — | — | — |
| Rimantadine Hydrochloride Rimantadine Hydrochloride | — Medicare Part D | — | — | — |
| Larin Fe 1.5/30 Norethindrone Acetate/Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| SOLIFENACIN SUCCINATE Solifenacin Succinate | — Medicare Part D | — | — | — |
| Ampicillin Sodium Ampicillin sodium | — Medicare Part D | — | — | — |
| Lidocaine HCl 3% and Hydrocortisone Acetate1% Cream Lidocaine HCl and Hydrocortisone Acetate | — Medicare Part D | — | — | — |
| Rivelsa Levonorgestrel/Ethinyl Estradiol and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Dacarbazine DACARBAZINE | — Medicare Part D | — | — | — |
| MIEBO Perfluorohexyloctane | — Medicare Part D | — | — | — |