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 |
|---|---|---|---|---|
| Guanfacine ER Guanfacine ER | — Medicare Part D | — | — | — |
| ALBUTEROL SULFATE ALBUTEROL SULFATE | — Medicare Part D | — | — | — |
| CLINDAMYCIN HYDROCHLORIDE Clindamycin Hydrochloride | — Medicare Part D | — | — | — |
| Floriva CHOLECALCIFEROL and SODIUM FLUORIDE | — Medicare Part D | — | — | — |
| CIMERLI ranibizumab-eqrn | — Medicare Part D | — | — | — |
| Doxepin Hydrochloride doxepin hydrochloride | — Medicare Part D | — | — | — |
| Gemfibrozil Gemfibrozil | — Medicare Part D | — | — | — |
| Abiraterone Acetate Abiraterone Acetate | — Medicare Part D | — | — | — |
| Gestyra ASCORBIC ACID, CHOLECALCIFEROL, THIAMINE, PYRIDOXAL PHOSPHATE, FOLIC ACID, METHYLCOBALAMIN, CALCIUM CARBONATE, FERROUS GLUCONATE, POTASSIUM IODIDE | — Medicare Part D | — | — | — |
| FERRIPROX deferiprone | — Medicare Part D | — | — | — |
| Epinephrine EPINEPHRINE | — Medicare Part D | — | — | — |
| TRESIBA insulin degludec | — Medicare Part D | Yes | — | — |
| DESIPRAMINE HYDROCHLORIDE Desipramine Hydrochloride | — Medicare Part D | — | — | — |
| ENDOMETRIN Progesterone | — Medicare Part D | — | — | — |
| Glipizide and Metformin HCl Glipizide and Metformin HCl | — Medicare Part D | — | — | — |
| Ibutilide Fumarate ibutilide fumarate | — Medicare Part D | — | — | — |
| JELMYTO mitomycin | — Medicare Part D | — | — | — |
| Caffeine Citrate Oral Solution caffeine citrate | — Medicare Part D | — | — | — |
| AMONDYS 45 casimersen | — Medicare Part D | — | — | — |
| Clomid Clomiphene Citrate | — Medicare Part D | — | — | — |
| Glycerol Phenylbutyrate glycerol phenylbutyrate | — Medicare Part D | — | — | — |
| Clotrimazole/Betameth Clotrimazole/Betameth | — Medicare Part D | — | — | — |
| Ultravist iopromide | — Medicare Part D | — | — | — |
| Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution | — Medicare Part D | — | — | — |
| Phexxi lactic acid, L-, citric acid monohydrate, and potassium bitartrate | — Medicare Part D | — | — | — |
| Ella ulipristal acetate | — Medicare Part D | — | — | — |
| PCXX CREME DE MENTHE APF G Sodium Fluoride | — Medicare Part D | — | — | — |
| Sodium Chloride Sodium Chloride | — Medicare Part D | — | — | — |
| LOTEPREDNOL ETABONATE Loteprednol Etabonate | — Medicare Part D | — | — | — |
| NutriLipid I.V. Fat Emulsion Soybean Oil | — Medicare Part D | Yes | — | — |
| CYTARABINE cytarabine | — Medicare Part D | — | — | — |
| Vita-Rx Diabetic Vitamin Vitamin C, Vitamin D, Vitamin E, Thiamine, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Biotin, Pantothenic Acid, Chromium | — Medicare Part D | — | — | — |
| CHLORTHALIDONE Chlorthalidone | — Medicare Part D | — | — | — |
| Renova Tretinoin | — Medicare Part D | — | — | — |
| PREZCOBIX DARUNAVIR ETHANOLATE and COBICISTAT | — Medicare Part D | — | — | — |
| BETAMETHASONE DIPROPIONATE Betamethasone dipropionate | — Medicare Part D | — | — | — |
| Sodium Thiosulfate SODIUM THIOSULFATE | — Medicare Part D | — | — | — |
| Estradiol Valerate and Estradiol Valerate/Dienogest estradiol valerate and estradiol valerate/dienogest | — Medicare Part D | — | — | — |
| Mirvaso brimonidine tartrate | — Medicare Part D | — | — | — |
| Eczemol Potassium Bromide, Nickel Sulfate, and Sulfur | — Medicare Part D | — | — | — |
| Tafluprost Tafluprost | — Medicare Part D | — | — | — |
| XOLREMDI mavorixafor | — Medicare Part D | — | — | — |
| PRED MILD prednisolone acetate | — Medicare Part D | — | — | — |
| ROCTAVIAN valoctocogene roxaparvovec-rvox | — Medicare Part D | — | — | — |
| CHLORDIAZEPOXIDE HYDROCHLORIDE AND CLIDINIUM BROMIDE Chlordiazepoxide Hydrochloride and Clidinium Bromide | — Medicare Part D | — | — | — |
| Fidaxomicin FIDAXOMICIN | — Medicare Part D | — | — | — |
| FYLNETRA pegfilgrastim | — Medicare Part D | Yes | — | — |
| NITROGLYCERIN Nitroglycerin | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE Bupropion hydrochloride | — Medicare Part D | — | — | — |
| Icosapent icosapent ethyl | — Medicare Part D | — | — | — |