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 |
|---|---|---|---|---|
| TICAGRELOR Ticagrelor | — Medicare Part D | — | — | — |
| Olanzapine Olanzapine | — Medicare Part D | — | — | — |
| SOLU-MEDROL(R) METHYLPREDNISOLONE SODIUM SUCCINAT | — Medicare Part D | — | — | — |
| SOLU-MEDROL methylprednisolone sodium succinate | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 5/95 Oxygen/Nitrogen 5/95 | — Medicare Part D | — | — | — |
| Anticoagulant Citrate Dextrose A ACD-A Anticoagulant Citrate Dextrose A ACD-A | — Medicare Part D | — | — | — |
| Arformoterol Tartrate Inhalation Arformoterol Tartrate Inhalation | — Medicare Part D | — | — | — |
| CALCIUM CHLORIDE SODIUM CHLORIDE, SODIUM LACTATE, POTASSIUM CHLORIDE, and CALCIUM CHLORIDE | — Medicare Part D | — | — | — |
| Iohexol Iohexol | — Medicare Part D | — | — | — |
| Triazolam triazolam | — Medicare Part D | — | — | — |
| Retin-A Tretinoin | — Medicare Part D | — | — | — |
| Loteprednol etabonate and Tobramycin Loteprednol etabonate and Tobramycin | — Medicare Part D | — | — | — |
| SLYND Drospirenone | — Medicare Part D | — | — | — |
| Rugby All Day Relief Naproxen Sodium | — Medicare Part D | — | — | — |
| DICLEGIS doxylamine succinate and pyridoxine hydrochloride | — Medicare Part D | — | — | — |
| Actoplus Met pioglitazone and metformin hydrochloride | — Medicare Part D | — | — | — |
| RISPERIDONE Risperidone | — Medicare Part D | — | — | — |
| Physician EZ Use Joint Tunnel and Trigger Kit AMMONIA, LIDOCAINE HYDROCHLORIDE, TRIAMCINOLONE ACETONIDE, POVIDONE-IODINE | — Medicare Part D | — | — | — |
| Pramipexole Dihydrochloride Pramipexole Dihydrochloride | — Medicare Part D | — | — | — |
| Bumetanide Bumetanide | — Medicare Part D | — | — | — |
| DOXYCYCLINE DOXYCYCLINE DOXYCYCLINE | — Medicare Part D | — | — | — |
| KEYTRUDA QLEX pembrolizumab and berahyaluronidase alfa-pmph | — Medicare Part D | — | — | — |
| Prenatal Plus Vitamins prenatal with ferrous fumarate and folic acid | — Medicare Part D | — | — | — |
| N/A ATROPINE SULFATE INJECTION USP, 0.5 MG/0.7 ML | — Medicare Part D | — | — | — |
| Silver Nitrate SILVER NITRATE | — Medicare Part D | — | — | — |
| Constulose Lactulose | — Medicare Part D | — | — | — |
| Osphena Ospemifene | — Medicare Part D | — | — | — |
| OHM-CIR Baryta Iodata, Cactus Grandiflorus, Carbo Vegetabilis, Crataegus Oxyacantha, Curare, Kali Carbonicum, Kalmia Latifolia, Melilotus Officinale, Naja Tripudians, Secale Cornutum, Solanum Nigrum, Spigelia Anthelmia | — Medicare Part D | — | — | — |
| KINEVAC sincalide | — Medicare Part D | — | — | — |
| Levalbuterol tartrate HFA inhalation levalbuterol tartrate | — Medicare Part D | — | — | — |
| Flotrex Multivitamins, Sodium Fluoride 0.5 mg | — Medicare Part D | — | — | — |
| BOTOX onabotulinumtoxinA | — Medicare Part D | — | — | — |
| Edarbyclor Azilsartan kamedoxomil and chlorthalidone | — Medicare Part D | — | — | — |
| ENDOCET Oxycodone and Acetaminophen | — Medicare Part D | — | — | — |
| TRIAMTERENE AND HYDROCHLOROTHIAZIDE Triamterene and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| RAPIBLYK landiolol | — Medicare Part D | — | — | — |
| CHLORPROMAZINE HCI CHLORPROMAZINE HCI | — Medicare Part D | — | — | — |
| Febuxostat febuxostat | — Medicare Part D | — | — | — |
| MYHIBBIN MYCOPHENOLATE MOFETIL | — Medicare Part D | — | — | — |
| Mometasone Furoate Mometasone Furoate | — Medicare Part D | — | — | — |
| CLONIDINE HCI CLONIDINE HCI | — Medicare Part D | — | — | — |
| LANTUS SOLOSTAR insulin glargine | — Medicare Part D | — | — | — |
| Rizatriptan Benzoate ODT Rizatriptan Benzoate ODT | — Medicare Part D | — | — | — |
| Hydroxyzine Hydrochloride Hydroxyzine hydrochloride | — Medicare Part D | — | — | — |
| Stoboclo denosumab-bmwo | — Medicare Part D | Yes | — | — |
| TOPROL XL Metoprolol Succinate | — Medicare Part D | — | — | — |
| Kalydeco ivacaftor | — Medicare Part D | — | — | — |
| Levothyroxine Sodium Levothyroxine Sodium | — Medicare Part D | — | — | — |
| VALGANCICLOVIR Valganciclovir | — Medicare Part D | — | — | — |
| TRIMO SAN Oxyquinoline Sulfate and Sodium Lauryl Sulfate | — Medicare Part D | — | — | — |