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 |
|---|---|---|---|---|
| Ethambutol Hydrochloride Ethambutol Hydrochloride | — Medicare Part D | — | — | — |
| Diclofenac Sodium DR Diclofenac Sodium | — Medicare Part D | — | — | — |
| Angeliq drospirenone and estradiol | — Medicare Part D | — | — | — |
| FLUDROCORTISONE ACETATE FLUDROCORTISONE ACETATE | — Medicare Part D | — | — | — |
| SUMATRIPTAN Sumatriptan Succinate | — Medicare Part D | — | — | — |
| Tramadol Hydrochloride TRAMADOL HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Pilocarpine Hydrochloride Pilocarpine Hydrochloride | — Medicare Part D | — | — | — |
| Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution | — Medicare Part D | — | — | — |
| ZITUVIMET XR sitagliptin and metformin hydrochloride | — Medicare Part D | — | — | — |
| ENALAPRIL MALEATE Enalapril Maleate | — Medicare Part D | — | — | — |
| SODIUM ACETATE Sodium Acetate | — Medicare Part D | — | — | — |
| Deflazacort, DEFLAZACORT | — Medicare Part D | Yes | — | — |
| Bisoprolol Fumarate and Hydrochlorothiazide bisoprolol fumarate and hydrochlorothiazide | — Medicare Part D | — | — | — |
| TAZORAC tazarotene | — Medicare Part D | — | — | — |
| pilocarpine hydrchloride pilocarpine hydrchloride | — Medicare Part D | — | — | — |
| TROMETHAMINE Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| TOSYMRA Sumatriptan | — Medicare Part D | — | — | — |
| Rufinamide rufinamide | — Medicare Part D | — | — | — |
| Heparin Sodium and Dextrose HEPARIN SODIUM | — Medicare Part D | — | — | — |
| Choleystyramine Light Choleystyramine Light | — Medicare Part D | — | — | — |
| Phenobarbital, Hyoscyamine Sulfate, Atropine Sulfate and Scopolamine Hydrobromide Phenobarbital, Hyoscyamine Sulfate, Atropine Sulfate and Scopolamine Hydrobromide | — Medicare Part D | — | — | — |
| ADCETRIS brentuximab vedotin | — Medicare Part D | — | — | — |
| SODIUM SULFACETAMIDE and SULFUR Wash SODIUM SULFACETAMIDE and SULFUR | — Medicare Part D | — | — | — |
| TENORETIC Atenolol and Chlorthalidone | — Medicare Part D | — | — | — |
| Pregabalin Extended Release PREGABALIN | — Medicare Part D | — | — | — |
| Fluorescein fluorescein | — Medicare Part D | — | — | — |
| Roxicodone oxycodone hydrochloride | — Medicare Part D | — | — | — |
| ZEPATIER elbasvir and grazoprevir | — Medicare Part D | — | — | — |
| Rapivab peramivir | — Medicare Part D | — | — | — |
| TERUFLEX BLOOD with Diversion Blood Sampling Arm 70 mL CPDA-1 | — Medicare Part D | — | — | — |
| Octreotide Octreotide | — Medicare Part D | — | — | — |
| CitraNatal 90 DHA Vitamin C, Calcium, Iron, Vitamin D3, Vitamin E, Thiamin, Riboflavin, Niacinamide, Vitamin B6, Folic Acid, Iodine, Zinc, Copper, Docusate Sodium | — Medicare Part D | — | — | — |
| SODIUM SULFATE, POTASSIUM SULFATE AND MAGNESIUM SULFATE Sodium Sulfate, Potassium Sulfate and Magnesium Sulfate | — Medicare Part D | — | — | — |
| Prednisolone Sodium Phosphate prednisoLONE sodium phosphate | — Medicare Part D | — | — | — |
| Fluocinolone Acetonide Topical Solution USP, 0.01% | — Medicare Part D | — | — | — |
| Trazodone HCL Trazodone HCl | — Medicare Part D | — | — | — |
| Cefuroxime and Dextrose CEFUROXIME AND DEXTROSE | — Medicare Part D | — | — | — |
| ROSUVASTATIN CALCIUM Rosuvastatin Calcium | — Medicare Part D | — | — | — |
| Vecamyl Mecamylamine Hydrochloride | — Medicare Part D | — | — | — |
| AZACTAM AZTREONAM | — Medicare Part D | — | — | — |
| Ofev nintedanib | — Medicare Part D | — | — | — |
| METHYLPHENIDATE HYDROCHLORIDE EXTENDED RELEASE methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Macrilen Macimorelin acetate | — Medicare Part D | — | — | — |
| LEXISCAN(R) (REGADENOSON) regadenoson | — Medicare Part D | — | — | — |
| Velphoro sucroferric oxyhydroxide | — Medicare Part D | — | — | — |
| Diabecin HR Lidocaine HCl, Benzalkonium Chloride | — Medicare Part D | — | — | — |
| Valproate Sodium Valproate Sodium | — Medicare Part D | — | — | — |
| Budesonide Inhalation budesonide inhalation | — Medicare Part D | — | — | — |
| Travatan Z travoprost | — Medicare Part D | — | — | — |
| venlafaxine hydrochloride, extended release venlafaxine hydrochloride, extended release | — Medicare Part D | — | — | — |