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 |
|---|---|---|---|---|
| Vandazole Metronidazole | — Medicare Part D | — | — | — |
| Kit for the preparation of Lymphoseek (technetium Tc 99m tilmanocept) tilmanocept | — Medicare Part D | — | — | — |
| Acclean Chlorhexidine Gluconate 0.12% Oral Rinse | — Medicare Part D | — | — | — |
| Melphalan Melphalan hydrochloride | — Medicare Part D | — | — | — |
| APHEXDA Motixafortide | — Medicare Part D | — | — | — |
| Thymoglobulin Anti-thymocyte Globulin (Rabbit) | — Medicare Part D | — | — | — |
| TOFIDENCE Tocilizumab | — Medicare Part D | — | — | — |
| FLUOXETINE HYDROCHLORIDE Fluoxetine Hydrochloride | — Medicare Part D | — | — | — |
| QUZYTTIR Cetirizine Hydrochloride | — Medicare Part D | — | — | — |
| PCXX NEUTRAL RMS BUBBLEGUM FLUORIDE TREATMENT | — Medicare Part D | — | — | — |
| Cartia XT Diltiazem Hydrochloride | — Medicare Part D | — | — | — |
| Ledipasvir and Sofosbuvir LEDIPASVIR and SOFOSBUVIR | — Medicare Part D | — | — | — |
| NEOMYCIN AND POLYMYXIN B SULFATES AND HYDROCORTISONE neomycin sulfate, polymyxin b sulfate and hydrocortisone | — Medicare Part D | — | — | — |
| DEFERASIROX Deferasirox | — Medicare Part D | — | — | — |
| PERTZYE pancrelipase | — Medicare Part D | — | — | — |
| Raloxifene Hydrochloride Raloxifene hydrochloride | — Medicare Part D | — | — | — |
| Adrenalin Vials epinephrine | — Medicare Part D | — | — | — |
| CHROMIUM Chromium Metallicum | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE SR bupropion hydrochloride | — Medicare Part D | — | — | — |
| FENOFIBRIC ACID Fenofibric Acid | — Medicare Part D | — | — | — |
| Atrovent HFA ipratropium bromide | — Medicare Part D | — | — | — |
| Sucralfate Sucralfate | — Medicare Part D | — | — | — |
| VOTRIENT pazopanib hydrochloride | — Medicare Part D | — | — | — |
| Oxcarbazepine oxcarbazepine | — Medicare Part D | — | — | — |
| Tramadol Hydrochloride Extended-Release tramadol hydrochloride | — Medicare Part D | — | — | — |
| Veletri epoprostenol | — Medicare Part D | — | — | — |
| Pimozide Pimozide | — Medicare Part D | — | — | — |
| CycloSPORINE, Modfied Cyclosporine | — Medicare Part D | Yes | — | — |
| CIPROFLOXACIN HYDROCHLORIDE Ciprofloxacin Hydrochloride | — Medicare Part D | — | — | — |
| ATENOLOL AND CHLORTHALIDONE Atenolol and Chlorthalidone | — Medicare Part D | — | — | — |
| Bexarotene bexarotene | — Medicare Part D | — | — | — |
| Demser metyrosine | — Medicare Part D | — | — | — |
| posfrea palonosetron | — Medicare Part D | — | — | — |
| OVACE PLUS SULFACETAMIDE SODIUM | — Medicare Part D | — | — | — |
| CIMDUO Lamivudine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| ROPINIROLE ROPINIROLE | — Medicare Part D | — | — | — |
| SANCUSO granisetron | — Medicare Part D | — | — | — |
| Tri-Legest Fe 28 Day Norethindrone Acetate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| LEDERLE LEUCOVORIN CALCIUM FOLINATE | — Medicare Part D | — | — | — |
| OXYBUTYNIN CHLORIDE OXYBUTYNIN CHLORIDE | — Medicare Part D | — | — | — |
| Adapalene ADAPALENE | — Medicare Part D | — | — | — |
| JANUMET SITAGLIPTIN and METFORMIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Fludeoxyglucose F-18 FLUDEOXYGLUCOSE F-18 | — Medicare Part D | — | — | — |
| Butorphanol Tartrate Butorphanol Tartrate | — Medicare Part D | — | — | — |
| varenicline, Varenicline | — Medicare Part D | — | — | — |
| DULOXETINE DELAYED-RELEASE DULOXETINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Benicar HCT olmesartan medoxomil-hydrochlorothiazide | — Medicare Part D | — | — | — |
| FOSAPREPITANT FOSAPREPITANT | — Medicare Part D | — | — | — |
| MLK F1 Kit marcaine, lidocaine, kenalog, povidone iodine | — Medicare Part D | — | — | — |
| Trandolapril and Verapamil Hydrochloride Trandolapril and Verapamil Hydrochloride | — Medicare Part D | — | — | — |