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 |
|---|---|---|---|---|
| Tetracycline Hydrochloride Tetracycline Hydrochloride | — Medicare Part D | — | — | — |
| DRIZALMA SPRINKLE Duloxetine | — Medicare Part D | — | — | — |
| ALENDRONATE SODIUM Alendronate sodium | — Medicare Part D | — | — | — |
| Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals | — Medicare Part D | — | — | — |
| Humalog KwikPen Insulin lispro | — Medicare Part D | — | — | — |
| Jantoven Warfarin Sodium | — Medicare Part D | — | — | — |
| Imatinib mesylate 400 mg imatinib mesylate | — Medicare Part D | — | — | — |
| Paroxetine Paroxetine | — Medicare Part D | — | — | — |
| Iron Sucrose iron sucrose | — Medicare Part D | — | — | — |
| Felopdipine Felodipine | — Medicare Part D | — | — | — |
| COMPRESSED Gas, N.O.S. CARBON DIOXIDE, OXYGEN | — Medicare Part D | — | — | — |
| Spongilla lacustris MT Spongilla lacustris | — Medicare Part D | — | — | — |
| Levsin hyoscyamine sulfate | — Medicare Part D | — | — | — |
| Sterile Water STERILE WATER | — Medicare Part D | — | — | — |
| DARBY APF STRAWBERRY, DARBY APF MINT, DARBY APF BUBBLE GUM | — Medicare Part D | — | — | — |
| Cesamet Nabilone | — Medicare Part D | — | — | — |
| Mepivacaine Mepivacaine Hydrochloride | — Medicare Part D | — | — | — |
| RYSTIGGO ROZANOLIXIZUMAB | — Medicare Part D | — | — | — |
| TIGLUTIK Riluzole | — Medicare Part D | — | — | — |
| Alprazolam XR alprazolam | — Medicare Part D | — | — | — |
| BUTALBITAL, ACETAMINOPHEN AND CAFFEINE butalbital, acetaminophen and caffeine | — Medicare Part D | — | — | — |
| Carnitor levocarnitine | — Medicare Part D | — | — | — |
| Guanfacine Hydrochloride Guanfacine Hydrochloride | — Medicare Part D | — | — | — |
| Desferal deferoxamine mesylate | — Medicare Part D | — | — | — |
| Fulphila pegfilgrastim-jmdb | — Medicare Part D | Yes | — | — |
| RIDAURA auranofin | — Medicare Part D | — | — | — |
| Trifluridine Trifluridine | — Medicare Part D | — | — | — |
| MOXIFLOXACIN HYDROCHLORIDE MOXIFLOXACIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| ESOMEPRAZOLE STRONTIUM esomeprazole strontium | — Medicare Part D | — | — | — |
| Magnesium Sulfate in Water Magnesium Sulfate | — Medicare Part D | — | — | — |
| UNASYN ampicillin sodium and sulbactam sodium | — Medicare Part D | — | — | — |
| HELIUM HELIUM | — Medicare Part D | — | — | — |
| Norethindrone Acetate norethindrone acetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Synalar fluocinolone acetonide | — Medicare Part D | — | — | — |
| Minoxidil Minoxidil | — Medicare Part D | — | — | — |
| FML FORTE fluorometholone | — Medicare Part D | — | — | — |
| 1ST MEDXPATCH WITH LIDOCAINE 4%-RX LIDOCAINE, CAPSAICIN, MENTHOL, METHYL SALICYLATE | — Medicare Part D | — | — | — |
| TAZAROTENE TAZAROTENE | — Medicare Part D | — | — | — |
| Citalopram citalopram | — Medicare Part D | — | — | — |
| Erythromycin Ethylsuccinate Erythromycin Ethylsuccinate | — Medicare Part D | — | — | — |
| Sucraid sacrosidase | — Medicare Part D | — | — | — |
| TRODELVY SACITUZUMAB GOVITECAN | — Medicare Part D | — | — | — |
| Cyonanz Norethindrone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Felodipine, Felopdipine | — Medicare Part D | — | — | — |
| Uroxatral Alfuzosin HCl | — Medicare Part D | — | — | — |
| Dexmethylphenidate Hydrochloride Extended-Release dexmethylphenidate hydrochloride | — Medicare Part D | — | — | — |
| VEVYE cyclosporine ophthalmic solution | — Medicare Part D | — | — | — |
| Aveed testosterone undecanoate | — Medicare Part D | Yes | — | — |
| KETOROLAC TROMETHAMINE Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| Dyural 80-LM Methylprednisolone Acetate, Lidocaine Hydrochloride, Bupivacaine Hydrochloride, Povidine Iodine, Isopropyl Alcohol | — Medicare Part D | — | — | — |