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 |
|---|---|---|---|---|
| EDURANT, EDURANT PED | — Medicare Part D | — | — | — |
| Ritalin LA methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| URIMAR-T CAPS methenamine, sodium phosphate, monobasic, monohydrate, phenyl salicylate, methylene blue, and hyoscyamine sulfate | — Medicare Part D | — | — | — |
| Tramadol Hydrochloride TRAMADOL HYDROCHLORIDE | — Medicare Part D | — | — | — |
| AZITHROMYCIN DIHYDRATE Azithromycin dihydrate | — Medicare Part D | — | — | — |
| KRISTALOSE lactulose | — Medicare Part D | — | — | — |
| ALBENZA albendazole | — Medicare Part D | — | — | — |
| ERBITUX cetuximab | — Medicare Part D | — | — | — |
| Neupro rotigotine | — Medicare Part D | — | — | — |
| Etodolac ER Etodolac | — Medicare Part D | — | — | — |
| Esmolol Hydrochloride, esmolol hydrochloride | — Medicare Part D | — | — | — |
| BUTALBITAL AND ACETAMINOPHEN butalbital and acetaminophen | — Medicare Part D | — | — | — |
| APHEXDA Motixafortide | — Medicare Part D | — | — | — |
| PROPAFENONE HYDROCHLORIDE Propafenone Hydrochloride | — Medicare Part D | — | — | — |
| EXXUA gepirone | — Medicare Part D | — | — | — |
| PHENDIMETRAZINE TARTRATE Phendimetrazine Tartrate | — Medicare Part D | — | — | — |
| VYXEOS (daunorubicin and cytarabine) liposome | — Medicare Part D | — | — | — |
| Retisert Fluocinolone Acetonide | — Medicare Part D | — | — | — |
| LANSOPRAZOLE LANSOPRAZOLE | — Medicare Part D | — | — | — |
| Nikki drospirenone and ethinyl estradiol | — Medicare Part D | — | — | — |
| Imbruvica Ibrutinib | — Medicare Part D | Yes | — | — |
| NITHIODOTE Sodium Nitrite and Sodium Thiosulfate | — Medicare Part D | — | — | — |
| CAPRELSA Vandetanib | — Medicare Part D | — | — | — |
| SERTRALINE Sertraline | — Medicare Part D | — | — | — |
| FEIRZA 1.5/30 TM Norethindrone Acetate and Ethinyl Estradiol Tablets USP, 1.5 mg/30 mcg and Ferrous Fumarate Tablets, 75 mg | — Medicare Part D | — | — | — |
| Acamprosate Calcium acamprosate calcium | — Medicare Part D | — | — | — |
| Nitrogen Oxygen Mix Nitrogen Oxygen Mix | — Medicare Part D | — | — | — |
| Teflaro ceftaroline fosamil | — Medicare Part D | Yes | — | — |
| BENZONATATE Benzonatate | — Medicare Part D | — | — | — |
| EBANGA Ansuvimab | — Medicare Part D | — | — | — |
| Fludeoxyglucose F-18 FLUDEOXYGLUCOSE F-18 | — Medicare Part D | — | — | — |
| Curosurf poractant alfa | — Medicare Part D | — | — | — |
| REPATHA Evolocumab | — Medicare Part D | Yes | — | — |
| IODOQUINOL, HYDROCORTISONE ACETATE, ALOE POLYSACCHARIDES IODOQUINOL, HYDROCORTISONE ACETATE, ALOE POLYSACCHARIDES | — Medicare Part D | — | — | — |
| Brompheniramine Maleate, Pseudoephedrine Hydrochloride and Dextromethorphan Hydrobromide Brompheniramine Maleate, Pseudoephedrine Hydrochloride and Dextromethorphan Hydrobromide | — Medicare Part D | — | — | — |
| Venlafaxine HCL ER Venlafaxine HCL ER | — Medicare Part D | — | — | — |
| Avar-e Green SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| Xultophy 100/3.6 insulin degludec and liraglutide | — Medicare Part D | Yes | — | — |
| Glycopyrrolate Glycopyrrolate | — Medicare Part D | — | — | — |
| ZOMIG Zolmitriptan | — Medicare Part D | — | — | — |
| Helium Oxygen mixture Helium Oxygen mixture | — Medicare Part D | — | — | — |
| Atelvia risedronate sodium | — Medicare Part D | — | — | — |
| XYWAV calcium, magnesium, potassium, and sodium oxybates | — Medicare Part D | — | — | — |
| Hydroquinone 4% Hydroquinone | — Medicare Part D | — | — | — |
| Clindamycin Palmitate Hydrochloride Clindamycin Palmitate Hydrochloride | — Medicare Part D | — | — | — |
| INVEGA TRINZA paliperidone palmitate | — Medicare Part D | Yes | — | — |
| HAILEY Fe 1/20 norethindrone acetate and ethinyl estradiol and ferrous fumarate | — Medicare Part D | — | — | — |
| Tivicay, Tivicay PD | — Medicare Part D | — | — | — |
| Carboplatin CARBOPLATIN | — Medicare Part D | — | — | — |
| ZUNVEYL benzgalantamine | — Medicare Part D | — | — | — |