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 |
|---|---|---|---|---|
| IMUFLEX WB-RP Blood Bag System with Integral Whole Blood Leukocyte Reduction Filter (Removing Platelets) with Diversion Blood Sampling Arm Anticoagulant Citrate Phosphate Dextrose (CPD) AND OPTISOL (AS-5) Red Cell Preservative | — Medicare Part D | — | — | — |
| HALCINONIDE Halcinonide | — Medicare Part D | — | — | — |
| Fluticasone Propionate and Salmeterol Fluticasone Propionate and Salmeterol | — Medicare Part D | — | — | — |
| JAVADIN clonidine hydrochloride oral | — Medicare Part D | — | — | — |
| AK-FLUOR fluorescein | — Medicare Part D | — | — | — |
| LIDOCAINE HCI, LIDOCAINE HCl | — Medicare Part D | — | — | — |
| Procainamide Hydrochloride Procainamide Hydrochloride | — Medicare Part D | — | — | — |
| Sumatriptan and Naproxen Sodium Sumatriptan and Naproxen Sodium | — Medicare Part D | — | — | — |
| OPVEE nalmefene hydrochloride | — Medicare Part D | Yes | — | — |
| HALOPERIDOL LACTATE HALOPERIDOL LACTATE | — Medicare Part D | — | — | — |
| sodium nitroprusside in 0.9% sodium chloride sodium nitroprusside in 0.9% sodium chloride | — Medicare Part D | — | — | — |
| LEUPROLIDE ACETATE Leuprolide Acetate | — Medicare Part D | — | — | — |
| Dofetilide 0.125mg, Dofetilide 0.25mg, Dofetilide 0.5mg | — Medicare Part D | — | — | — |
| Scartrate Cream | — Medicare Part D | — | — | — |
| Rizatriptan Rizatriptan Benzoate | — Medicare Part D | — | — | — |
| Chlordiazepoxide and Amitriptyline Hydrochloride chlordiazepoxide and amitriptyline hydrochloride | — Medicare Part D | — | — | — |
| Nplate romiplostim | — Medicare Part D | — | — | — |
| REBINYN coagulation factor IX recombinant, GlycoPEGylated | — Medicare Part D | — | — | — |
| Allday 5000 1.1% Sodium Fluoride Toothpaste | — Medicare Part D | — | — | — |
| Daptomycin daptomycin | — Medicare Part D | — | — | — |
| CAPLYTA lumateperone | — Medicare Part D | — | — | — |
| Orapred ODT prednisolone sodium phosphate | — Medicare Part D | — | — | — |
| ADMELOG insulin lispro | — Medicare Part D | — | — | — |
| Niferex ferrous asparto glycinate, iron, ascorbic acid, folic acid, cyanocobalamin, zinc, and succinic acid | — Medicare Part D | — | — | — |
| Tecentriq Hybreza atezolizumab and hyaluronidase-tqjs | — Medicare Part D | — | — | — |
| Marlido 25 Kit Lidocaine Hydrochloride, Bupivacaine Hydrochloride, Povidine Iodine | — Medicare Part D | — | — | — |
| IVERMECTIN ivermectin | — Medicare Part D | — | — | — |
| VABYSMO Faricimab | — Medicare Part D | — | — | — |
| Nerlynx neratinib | — Medicare Part D | — | — | — |
| Protriptyline Hydrochloride Protriptyline Hydrochloride | — Medicare Part D | — | — | — |
| ZOCOR SIMVASTATIN | — Medicare Part D | — | — | — |
| Procardia XL nifedipine | — Medicare Part D | — | — | — |
| Minocycline Hydrochloride minocycline hydrochloride | — Medicare Part D | — | — | — |
| Polymyxin B Sulfate and Trimethoprim Polymyxin B Sulfate and Trimethoprim | — Medicare Part D | — | — | — |
| Clonidine Transdermal System USP, 0.1 mg/day, Clonidine Transdermal System USP, 0.2 mg/day, Clonidine Transdermal System USP, 0.3 mg/day | — Medicare Part D | — | — | — |
| TOBREX tobramycin | — Medicare Part D | — | — | — |
| Vienva Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Combogesic ACETAMINOPHEN and IBUPROFEN | — Medicare Part D | — | — | — |
| DORZOLAMIDE HYDROCHLORIDE dorzolamide hydrochloride | — Medicare Part D | — | — | — |
| Synarel nafarelin acetate | — Medicare Part D | — | — | — |
| Chlorpromazine Hydrochloride Chlorpromazine Hydrochloride | — Medicare Part D | — | — | — |
| BENZTROPINE MESYLATE BENZTROPINE MESYLATE | — Medicare Part D | — | — | — |
| ACCUTANE ISOTRETINOIN | — Medicare Part D | — | — | — |
| Hydrocodone Polistirex and Chlorpheniramine Polistirex extended-release Hydrocodone Polistirex and Chlorpheniramine Polistirex | — Medicare Part D | — | — | — |
| AMVUTTRA VUTRISIRAN | — Medicare Part D | — | — | — |
| Misoprostol MISOPROSTOL | — Medicare Part D | — | — | — |
| Ertapenem Ertapenem Sodium | — Medicare Part D | — | — | — |
| Halcinonide Topical Solution Halcinonide | — Medicare Part D | — | — | — |
| Dronabinol Dronabinol | — Medicare Part D | — | — | — |
| Bromocriptine Mesylate Bromocriptine Mesylate | — Medicare Part D | — | — | — |