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 |
|---|---|---|---|---|
| Chlorothiazide Chlorothiazide | — Medicare Part D | — | — | — |
| Bionara ULTRA Probiotic Dietary Supplement Capsules | — Medicare Part D | — | — | — |
| Gvoke HypoPen 0.5 mg Auto-Injector, Gvoke HypoPen 1 mg Auto-Injector, Gvoke PFS 1 mg Pre-filled Syringe, Gvoke Kit | — Medicare Part D | Yes | — | — |
| VORICONAZOLE Voriconazole | — Medicare Part D | — | — | — |
| Zenchent FE Norethindrone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Olmesartan medoxomil Amlodipine and Hydrochlorothiazide Olmesartan medoxomil, amlodipine and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Edaravone Edaravone | — Medicare Part D | Yes | — | — |
| Zarontin Ethosuximide | — Medicare Part D | — | — | — |
| BSS balanced salt solution | — Medicare Part D | — | — | — |
| Podocon 25 Podophyllum resin | — Medicare Part D | — | — | — |
| Helium Oxygen Nitrogen mixture Helium Oxygen Nitrogen mixture | — Medicare Part D | — | — | — |
| AUKELSO Denosumab-kyqq | — Medicare Part D | — | — | — |
| Genvoya elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide | — Medicare Part D | — | — | — |
| Ropivacaine Hydrochloride Ropivacaine Hydrochloride | — Medicare Part D | — | — | — |
| ADSTILADRIN nadofaragene firadenovec-vncg | — Medicare Part D | — | — | — |
| Amantadine Amantadine Hydrochloride | — Medicare Part D | — | — | — |
| Cefadroxil Cefadroxil | — Medicare Part D | — | — | — |
| Ambrisentan Ambrisentan | — Medicare Part D | — | — | — |
| JYLAMVO Methotrexate | — Medicare Part D | — | — | — |
| POKONZA potassium chloride potassium chloride | — Medicare Part D | — | — | — |
| Amitiza lubiprostone | — Medicare Part D | — | — | — |
| Timolol Maleate Timolol Maleate Ophthalmic | — Medicare Part D | — | — | — |
| WIDAPLIK telmisartan, amlodipine and indapamide | — Medicare Part D | — | — | — |
| Hyoscyamine Sulfate Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| Abacavir Abacavir | — Medicare Part D | — | — | — |
| Tagitol V Barium Sulfate | — Medicare Part D | — | — | — |
| Depo-Medrol methylprednisolone acetate | — Medicare Part D | — | — | — |
| Oxygen Size B, Oxygen Size C, Oxygen Size D, Oxygen Size E, Oxygen Size M, Oxygen Size F, Oxygen Size H, Oxygen Size T, Oxygen Size 400 | — Medicare Part D | — | — | — |
| Dipyridamole DIPYRIDAMOLE | — Medicare Part D | — | — | — |
| Ezetimibe EZETIMIBE | — Medicare Part D | — | — | — |
| PACLITAXEL Paclitaxel | — Medicare Part D | — | — | — |
| LUMISIGHT Pegulicianine | — Medicare Part D | — | — | — |
| FROVATRIPTAN Frovatriptan succinate | — Medicare Part D | — | — | — |
| Kionex Sodium Polystyrene Sulfonate | — Medicare Part D | — | — | — |
| Uretron D/S Methenamine, Sodium Phosphate Monobasic, Phenyl Salicylate, Methylene Blue, and Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| NALFON Fenoprofen Calcium | — Medicare Part D | — | — | — |
| Floxuridine Floxuridine | — Medicare Part D | — | — | — |
| Amlodipine besylate and Olmesartan medoxomil amlodipine besylate and olmesartan medoxomil | — Medicare Part D | — | — | — |
| Fluphenazine Hydrochloride fluphenazine hydrochloride | — Medicare Part D | — | — | — |
| Piperacillin and Tazobactam and Sodium Chloride Piperacillin and Tazobactam and Sodium Chloride | — Medicare Part D | — | — | — |
| IBANDRONATE SODIUM Ibandronate sodium | — Medicare Part D | — | — | — |
| Soma Carisoprodol | — Medicare Part D | — | — | — |
| Allergy Cetirizine Hydrochloride | — Medicare Part D | — | Step therapy | — |
| OSELTAMIVIR PHOSPHATE Oseltamivir phosphate | — Medicare Part D | — | — | — |
| CLONIDINE HYDROCHLORIDE clonidine hydrochloride | — Medicare Part D | — | — | — |
| Visceral Polarity Aconitum nap, Arg nit, Chininum pur, Echinacea purp, Plum met, Sepia, Sulphuricum ac | — Medicare Part D | — | — | — |
| pimavanserin pimavanserin | — Medicare Part D | — | — | — |
| Aptivus tipranavir | — Medicare Part D | — | — | — |
| Teriflunomide Teriflunomide | — Medicare Part D | — | — | — |
| IBUPROFEN AND FAMOTIDINE Ibuprofen and famotidine | — Medicare Part D | — | — | — |