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 |
|---|---|---|---|---|
| NovoLog Mix 70/30 insulin aspart | — Medicare Part D | — | — | — |
| AMLODIPINE BESYLATE Amlodipine Besylate | — Medicare Part D | — | — | — |
| VALTYA 1/35 ethynodiol diacetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| NITROFURANTOIN NITROFURANTOIN | — Medicare Part D | — | — | — |
| Sdamlo amlodipine | — Medicare Part D | — | — | — |
| FLUDROCORTISONE ACETATE FLUDROCORTISONE ACETATE | — Medicare Part D | — | — | — |
| XOPENEX HFA levalbuterol tartrate | — Medicare Part D | — | — | — |
| Oxygen, Compressed U.S.P. Oxygen, Compressed U.S.P. | — Medicare Part D | — | — | — |
| Proctosol-HC Hydrocortisone | — Medicare Part D | — | — | — |
| Analpram HC hydrocortisone acetate and pramoxine hydrochloride | — Medicare Part D | — | — | — |
| ZIOPTAN Tafluprost | — Medicare Part D | — | — | — |
| CABOMETYX cabozantinib | — Medicare Part D | — | — | — |
| PREGABALIN capsules, CV | — Medicare Part D | — | — | — |
| Lorbrena lorlatinib | — Medicare Part D | — | — | — |
| Topiramate Topiramate | — Medicare Part D | — | — | — |
| Medroxyprogesterone Medroxyprogesterone acetate | — Medicare Part D | — | — | — |
| Clinpro 5000 sodium fluoride | — Medicare Part D | — | — | — |
| NALOXONE HYDROCHLORIDE Naloxone Hydrochloride | — Medicare Part D | — | — | — |
| Minocin minocycline hydrochloride | — Medicare Part D | — | — | — |
| APREPITANT Aprepitant | — Medicare Part D | — | — | — |
| Attruby acoramidis hydrochloride | — Medicare Part D | — | — | — |
| AKEEGA NIRAPARIB TOSYLATE MONOHYDRATE and ABIRATERONE ACETATE | — Medicare Part D | — | — | — |
| VANRAFIA atrasentan | — Medicare Part D | — | — | — |
| LEUKERAN chlorambucil | — Medicare Part D | — | — | — |
| Prednisone prednisone | — Medicare Part D | — | — | — |
| TOLAK FLUOROURACIL | — Medicare Part D | — | — | — |
| Minivelle estradiol | — Medicare Part D | — | — | — |
| Doxycycline Hyclate doxycycline hyclate | — Medicare Part D | — | — | — |
| SIMVASTATIN Simvastatin | — Medicare Part D | — | — | — |
| Fluphenazine Decanoate Fluphenazine Decanoate | — Medicare Part D | — | — | — |
| Chloroprocaine Hydrochloride CHLOROPROCAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| ATROPINE SULFATE Atropine Sulfate | — Medicare Part D | — | — | — |
| BUTALBITAL, ACETAMINOPHEN AND CAFFEINE butalbital, acetaminophen and caffeine | — Medicare Part D | — | — | — |
| DOFETILIDE Dofetilide | — Medicare Part D | — | — | — |
| Caverject Alprostadil | — Medicare Part D | — | — | — |
| Carvedilol Carvedilol | — Medicare Part D | — | — | — |
| TriStart DHA ASCORBIC ACID, CHOLECALCIFEROL, .ALPHA.-TOCOPHEROL ACETATE, D-, THIAMINE HYDROCHLORIDE, RIBOFLAVIN, NIACIN, PYRIDOXINE HYDROCHLORIDE, LEVOMEFOLATE MAGNESIUM, FOLIC ACID, CYANOCOBALAMIN, IRON PENTACARBONYL, POTASSIUM IODIDE, MAGNESIUM OXIDE, DOCONEXENT, and ICOSAPENT | — Medicare Part D | — | — | — |
| Cabergoline Cabergoline | — Medicare Part D | — | — | — |
| CLOMIPRAMINE HYDROCHLORIDE Clomipramine Hydrochloride | — Medicare Part D | — | — | — |
| Primaquine Phosphate Primaquine Phosphate | — Medicare Part D | — | — | — |
| Megestrol Acetate Megestrol Acetate | — Medicare Part D | — | — | — |
| Bupivacaine Hydrochloride with Dextrose Bupivacaine Hydrochloride with Dextrose | — Medicare Part D | — | — | — |
| Micafungin Micafungin | — Medicare Part D | — | — | — |
| Microgestin Fe 1.5/30 Norethindrone Acetate/Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| PIPERACILLIN AND TAZOBACTAM Piperacillin and Tazobactam | — Medicare Part D | — | — | — |
| Naproxen Sodium Naproxen Sodium | — Medicare Part D | — | — | — |
| Tramadol HCL Tramadol HCl | — Medicare Part D | — | — | — |
| DEFENCATH taurolidine and heparin | — Medicare Part D | — | — | — |
| Foscarnet foscarnet sodium | — Medicare Part D | — | — | — |
| INFED Iron Dextran | — Medicare Part D | — | — | — |