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 |
|---|---|---|---|---|
| AZELASTINE HYDROCHLORIDE Azelastine Hydrochloride | — Medicare Part D | — | — | — |
| AJOVY fremanezumab-vfrm | — Medicare Part D | Yes | — | — |
| Bumex Bumetanide | — Medicare Part D | — | — | — |
| Cefixime Cefixime | — Medicare Part D | — | — | — |
| AMANTADINE HYDROCHLORIDE Amantadine Hydrochloride | — Medicare Part D | — | — | — |
| Meloxicam meloxicam | — Medicare Part D | — | — | — |
| Diazepam diazepam | — Medicare Part D | — | — | — |
| Cisatracurium CISATRACURIUM BESYLATE | — Medicare Part D | — | — | — |
| PODOFILOX Podofilox | — Medicare Part D | — | — | — |
| OVACE PLUS SULFACETAMIDE SODIUM | — Medicare Part D | — | — | — |
| ILLUCCIX Kit for the preparation of gallium Ga 68 gozetotide injection | — Medicare Part D | — | — | — |
| DEXMEDETOMIDINE HYDROCHLORIDE dexmedetomidine hydrochloride | — Medicare Part D | — | — | — |
| Terlivaz Terlipressin | — Medicare Part D | — | — | — |
| Timolol Maleate Ophthalmic Gel Forming Solution, 0.25%, Timolol Maleate Ophthalmic Gel Forming Solution, 0.5% | — Medicare Part D | — | — | — |
| BLUDIGO indigotindisulfonate sodium | — Medicare Part D | — | — | — |
| Quetiapine Quetiapine | — Medicare Part D | — | — | — |
| Pramipexole Dihydrochloride Extended-Release, Pramipexole Dihydrochloride | — Medicare Part D | — | — | — |
| WYOST denosumab | — Medicare Part D | Yes | — | — |
| LOPERAMIDE HYDROCHLORIDE Loperamide Hydrochloride | — Medicare Part D | — | — | — |
| Pregablin Pregablin | — Medicare Part D | — | — | — |
| VALCHLOR mechlorethamine hydrochloride | — Medicare Part D | — | — | — |
| CHOLBAM Cholic Acid | — Medicare Part D | — | — | — |
| Lucemyra lofexidine hydrochloride | — Medicare Part D | — | — | — |
| TEPEZZA teprotumumab | — Medicare Part D | — | — | — |
| ChiRhoStim, ChiRhoStim 40 | — Medicare Part D | — | — | — |
| Vectibix panitumumab | — Medicare Part D | — | — | — |
| Delestrogen estradiol valerate | — Medicare Part D | — | — | — |
| BROMFENAC SODIUM Bromfenac Sodium | — Medicare Part D | — | — | — |
| Esomeprazole Magnesium DR Esomeprazole Magnesium | — Medicare Part D | — | — | — |
| Olmesartan Medoxomil Olmesartan Medoxomil | — Medicare Part D | — | — | — |
| ZEGERID omeprazole and sodium bicarbonate | — Medicare Part D | — | — | — |
| Rolvedon eflapegrastim-xnst | — Medicare Part D | — | — | — |
| KRAZATI adagrasib | — Medicare Part D | — | — | — |
| Sodium Fluoride F 18 SODIUM FLUORIDE F-18 | — Medicare Part D | — | — | — |
| CEFTRIAXONE AND DEXTROSE CEFTRIAXONE | — Medicare Part D | — | — | — |
| SILDENAFIL CITRATE SILDENAFIL CITRATE | — Medicare Part D | — | — | — |
| IVABRADINE Ivabradine | — Medicare Part D | — | — | — |
| AMELUZ aminolevulinic acid hydrochloride | — Medicare Part D | — | — | — |
| TUBERSOL Tuberculin Purified Protein Derivative | — Medicare Part D | — | — | — |
| PHENOBARBITAL phenobarbital | — Medicare Part D | — | — | — |
| Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate | — Medicare Part D | — | — | — |
| IRON DEXTRAN IRON DEXTRAN | — Medicare Part D | — | — | — |
| RELENZA zanamivir | — Medicare Part D | — | — | — |
| MYLERAN busulfan | — Medicare Part D | — | — | — |
| DABIGATRAN ETEXILATE dabigatran etexilate | — Medicare Part D | — | — | — |
| Talicia omeprazole magnesium, amoxicillin and rifabutin | — Medicare Part D | — | — | — |
| Matulane procarbazine hydrochloride | — Medicare Part D | — | — | — |
| LETYBO letibotulinumtoxinA-wlbg | — Medicare Part D | — | — | — |
| Sirolimus Sirolimus | — Medicare Part D | — | — | — |
| NEUPOGEN Filgrastim | — Medicare Part D | Yes | — | — |