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 |
|---|---|---|---|---|
| Fintepla fenfluramine | — Medicare Part D | — | — | — |
| Sulfacetamide Sodium and Prednisolone Sodium Phosphate Sulfacetamide Sodium and Prednisolone Sodium Phosphate | — Medicare Part D | — | — | — |
| PADCEV EJFV ENFORTUMAB VEDOTIN | — Medicare Part D | — | — | — |
| DEXMEDETOMIDINE HYDROCHLORIDE IN 0.9% SODIUM CHLORIDE dexmedetomidine hydrochloride | — Medicare Part D | — | — | — |
| E-Z-HD barium sulfate | — Medicare Part D | — | — | — |
| Vitrexyl plus Iron Ferrous Fumarate, Folic Acid | — Medicare Part D | — | — | — |
| Potassium Chloride POTASSIUM CHLORIDE | — Medicare Part D | — | — | — |
| Arformoterol Tartrate Arformoterol Tartrate | — Medicare Part D | — | — | — |
| Betaloan SUIK Betamethasone Sodium Phosphate and Betamethasone Acetate | — Medicare Part D | — | — | — |
| Quetiapine Fumarate ER Quetiapine Fumarate ER | — Medicare Part D | — | — | — |
| VESIcare LS solifenacin succinate | — Medicare Part D | — | — | — |
| Forfivo XL bupropion hydrochloride | — Medicare Part D | — | — | — |
| Atorvastatin Calcium Atorvastatin Calcium | — Medicare Part D | — | — | — |
| ZYMAXID gatifloxacin | — Medicare Part D | — | — | — |
| Phentermine Hydrochloride PHENTERMINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| DEXAMETHASONE Dexamethasone | — Medicare Part D | — | — | — |
| Salicylic Acid 6% Gel SALICYLIC ACID | — Medicare Part D | — | — | — |
| Kineret anakinra | — Medicare Part D | Yes | — | — |
| CHOLESTYRAMINE cholestyramine | — Medicare Part D | — | — | — |
| Nizatidine Nizatidine | — Medicare Part D | — | — | — |
| Acamprosate Calcium acamprosate calcium | — Medicare Part D | — | — | — |
| Yargesa Miglustat | — Medicare Part D | — | — | — |
| CITALOPRAM HYDROBROMIDE CITALOPRAM HYDROBROMIDE | — Medicare Part D | — | — | — |
| Terazosin Terazosin Hydrochloride | — Medicare Part D | — | — | — |
| ESTRATEST F.S. ESTERIFIED ESTROGENS, METHYLTESTOSTERONE | — Medicare Part D | — | — | — |
| CHOLBAM Cholic Acid | — Medicare Part D | — | — | — |
| Pilocarpine Hydrochloride Ophthalmic Pilocarpine Hydrochloride | — Medicare Part D | — | — | — |
| QUVIVIQ Daridorexant | — Medicare Part D | — | — | — |
| XPHOZAH 10 mg, XPHOZAH 20 mg, XPHOZAH 30 mg | — Medicare Part D | — | — | — |
| Isosorbide Mononitrate Isosorbide Mononitrate | — Medicare Part D | — | — | — |
| Xyrem sodium oxybate | — Medicare Part D | — | — | — |
| PredniSONE Tablets, USP, 5 mg | — Medicare Part D | — | — | — |
| ODEFSEY emtricitabine, rilpivirine hydrochloride, and tenofovir alafenamide | — Medicare Part D | — | — | — |
| AZMIRO TESTOSTERONE CYPIONATE | — Medicare Part D | — | — | — |
| SSD Cream Silver Sulfadiazine | — Medicare Part D | — | — | — |
| PROCHLORPERAZINE MALEATE Prochlorperazine Maleate | — Medicare Part D | — | — | — |
| Qbrexza glycopyrronium | — Medicare Part D | — | — | — |
| Sincalide sincalide | — Medicare Part D | — | — | — |
| Balcoltra levonorgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| Estradiol ESTRADIOL | — Medicare Part D | — | — | — |
| THEOPHYLLINE Theophylline | — Medicare Part D | — | — | — |
| METHSCOPOLAMINE BROMIDE methscopolamine bromide | — Medicare Part D | — | — | — |
| RyVent carbinoxamine maleate | — Medicare Part D | — | — | — |
| VORICONAZOLE Voriconazole | — Medicare Part D | — | — | — |
| Flucytosine Flucytosine | — Medicare Part D | — | — | — |
| OxyContin oxycodone hydrochloride | — Medicare Part D | — | — | — |
| Mesalamine Mesalamine | — Medicare Part D | — | — | — |
| Vyleesi bremelanotide | — Medicare Part D | — | — | — |
| XARAH FE norethindrone acetate and ethinyl estradiol and ferrous fumarate tablets | — Medicare Part D | — | — | — |
| Pradaxa dabigatran etexilate | — Medicare Part D | — | — | — |