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 |
|---|---|---|---|---|
| Trisenox Arsenic Trioxide | — Medicare Part D | — | — | — |
| FOLIC ACID Folic Acid | — Medicare Part D | — | — | — |
| Bicalutamide Bicalutamide | — Medicare Part D | — | — | — |
| Davimet with Fluoride Multivitamin, Fluoride | — Medicare Part D | — | — | — |
| Isibloom desogestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| apomorphine hydrocloride APOMORPHINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Renflexis infliximab | — Medicare Part D | — | — | — |
| Esomeprazole Magnesium for delayed-release oral suspension Esomeprazole Magnesium | — Medicare Part D | — | — | — |
| ACETYLCYSTEINE ACETYLCYSTEINE | — Medicare Part D | — | — | — |
| Doxercalciferol DOXERCALCIFEROL | — Medicare Part D | — | — | — |
| Sodium Phenylbutyrate Sodium Phenylbutyrate | — Medicare Part D | — | — | — |
| Doxepin Hydrochloride doxepin hydrochloride | — Medicare Part D | — | — | — |
| Technescan MAG3 Technescan Tc 99m Mertiatide | — Medicare Part D | — | — | — |
| PHENOBARBITAL phenobarbital | — Medicare Part D | — | — | — |
| Dapsone Dapsone | — Medicare Part D | — | — | — |
| 60 Second Taste Strawberry Topical APF Fluoride Gel | — Medicare Part D | — | — | — |
| Timoptic-XE Timolol Maleate | — Medicare Part D | — | — | — |
| OPSYNVI macitentan and tadalafil | — Medicare Part D | — | — | — |
| Pentasa mesalamine | — Medicare Part D | — | — | — |
| BUTALBITAL, ASPIRIN, AND CAFFEINE Butalbital, aspirin, and caffeine | — Medicare Part D | — | — | — |
| VennGel One diclofenac sodium, isopropyl alcohol | — Medicare Part D | — | — | — |
| Linezolid Linezolid | — Medicare Part D | — | — | — |
| Milrinone Lactate Milrinone Lactate | — Medicare Part D | — | — | — |
| Regonol Pyridostigmine Bromide | — Medicare Part D | — | — | — |
| Kit for the Preparation of Technetium Tc99m Sestamibi TECHNETIUM TC-99M SESTAMIBI | — Medicare Part D | — | — | — |
| Desloratadine Oral Solution DESLORATADINE | — Medicare Part D | — | — | — |
| Vivelle-Dot estradiol | — Medicare Part D | — | — | — |
| WAINUA EPLONTERSEN | — Medicare Part D | Yes | — | — |
| Guanfacine Extended-Release guanfacine | — Medicare Part D | — | — | — |
| PHENTOLAMINE MESYLATE Phentolamine Mesylate | — Medicare Part D | — | — | — |
| Quinapril HCL and Hydrochlorothiazide Quinapril HCl and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Isradipine Isradipine | — Medicare Part D | — | — | — |
| AMIODARONE HCI AMIODARONE HCI | — Medicare Part D | — | — | — |
| Medrol methylprednisolone | — Medicare Part D | — | — | — |
| CPD/ADSOL anticoagulant citrate phosphate dextrose (cpd) and adsol preservation | — Medicare Part D | — | — | — |
| Procainamide Hydrochloride Procainamide Hydrochloride | — Medicare Part D | — | — | — |
| Methenamine Hippurate Methenamine hippurate | — Medicare Part D | — | — | — |
| Pioglitazone Hydrochloride and Metformin Hydrochloride Pioglitazone Hydrochloride and Metformin Hydrochloride | — Medicare Part D | — | — | — |
| PLIAGLIS Lidocaine and Tetracaine | — Medicare Part D | — | — | — |
| ENALAPRILAT Enalaprilat | — Medicare Part D | — | — | — |
| FOCINVEZ FOSAPREPITANT DIMEGLUMINE | — Medicare Part D | — | — | — |
| INDOMETHACIN Indomethacin | — Medicare Part D | — | — | — |
| Lomotil diphenoxylate hydrochloride and atropine sulfate | — Medicare Part D | — | — | — |
| Beleodaq Belinostat | — Medicare Part D | — | — | — |
| FORMOTEROL FUMARATE Formoterol Fumarate | — Medicare Part D | — | — | — |
| Guanfacine Hydrochloride Guanfacine Hydrochloride | — Medicare Part D | — | — | — |
| Zidovudine zidovudine | — Medicare Part D | — | — | — |
| Propranolol Hydrochloride ER propranolol hydrochloride | — Medicare Part D | — | — | — |
| Sodium Fluoride Sodium fluoride | — Medicare Part D | — | — | — |
| OHM-PAN Carbo Vegetabilis, Ceanothus Americanus, Gallium Aparine, Leptandra Virginica, Mandragora Officinarum, Momordica Balsamina, Quassia Amara | — Medicare Part D | — | — | — |