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 |
|---|---|---|---|---|
| Bupivacaine Hydrochloride and Epinephrine BUPIVACAINE HYDROCHLORIDE AND EPINEPHRINE | — Medicare Part D | — | — | — |
| Enoxaparin Sodium enoxaparin sodium | — Medicare Part D | — | — | — |
| OSELTAMIVIR Oseltamivir | — Medicare Part D | — | — | — |
| Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate Extended-Release Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate | — Medicare Part D | — | — | — |
| DIANEAL LOW CALCIUM WITH DEXTROSE sodium chloride, sodium lactate, calcium chloride, magnesium chloride and dextrose | — Medicare Part D | — | — | — |
| FLUCONAZOLE Fluconazole | — Medicare Part D | — | — | — |
| AVAR SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| CHLORDIAZEPOXIDE HYDROCHLORIDE AND CLIDINIUM BROMIDE Chlordiazepoxide Hydrochloride and Clidinium Bromide | — Medicare Part D | — | — | — |
| Streptococcinum STREPTOCOCCUS PYOGENES | — Medicare Part D | — | — | — |
| Carbon Dioxide Carbon Dioxide | — Medicare Part D | — | — | — |
| E-Z-Disk barium sulfate | — Medicare Part D | — | — | — |
| Pirfenidone Capsule, 267 mg | — Medicare Part D | — | — | — |
| Edarbi Azilsartan kamedoxomil | — Medicare Part D | — | — | — |
| CHLORTHALIDONE CHLORTHALIDONE CHLORTHALIDONE | — Medicare Part D | — | — | — |
| ULTRAMICROSIZE GRISEOFULVIN ULTRAMICROSIZE GRISEOFULVIN | — Medicare Part D | — | — | — |
| Phenytek extended phenytoin sodium | — Medicare Part D | — | — | — |
| Hydroxyzine Hydrochloride Hydroxyzine hydrochloride | — Medicare Part D | — | — | — |
| Vilazodone Hydrochloride vilazodone hydrochloride | — Medicare Part D | — | — | — |
| LANTUS SOLOSTAR insulin glargine | — Medicare Part D | — | — | — |
| UPTRAVI, UPTRAVI Titration Pack | — Medicare Part D | Yes | — | — |
| AXTLE pemetrexed | — Medicare Part D | — | — | — |
| FENOFIBRIC ACID Fenofibric Acid | — Medicare Part D | — | — | — |
| Ceftriaxone Ceftriaxone Sodium | — Medicare Part D | — | — | — |
| TRI-LO-MARZIA norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |
| KLOR-CON potassium chloride | — Medicare Part D | — | — | — |
| Octreotide Acetate Octreotide Acetate | — Medicare Part D | — | — | — |
| Air Air | — Medicare Part D | — | — | — |
| Riluzole Riluzole | — Medicare Part D | — | — | — |
| Urea Cream 40% Urea | — Medicare Part D | — | — | — |
| TRANEXAMIC ACID TRANEXAMIC ACID | — Medicare Part D | — | — | — |
| INDOCIN indomethacin | — Medicare Part D | — | — | — |
| Azelastine Hydrochloride Ophthalmic Solution 0.05% | — Medicare Part D | — | — | — |
| Citanest Forte DENTAL prilocaine hcl and epinephrine | — Medicare Part D | — | — | — |
| SUMATRIPTAN SUCCINATE Sumatriptan Succinate | — Medicare Part D | — | — | — |
| Levocetirizine Dihydrochloride levocetirizine Dihydrochloride | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 30/70 Oxygen/Nitrogen 30/70 | — Medicare Part D | — | — | — |
| POTASSIUM CITRATE EXTENDED RELEASE POTASSIUM CITRATE | — Medicare Part D | — | — | — |
| Amphotericin B liposome Amphotericin B liposome | — Medicare Part D | — | — | — |
| Rybrevant Amivantamab | — Medicare Part D | — | — | — |
| CHLOROTHIAZIDE SODIUM CHLOROTHIAZIDE SODIUM | — Medicare Part D | — | — | — |
| ORSERDU Elacestrant | — Medicare Part D | — | — | — |
| SCEMBLIX asciminib | — Medicare Part D | — | — | — |
| Fluvastatin Fluvastatin | — Medicare Part D | — | — | — |
| Foscarnet Sodium foscarnet sodium | — Medicare Part D | — | — | — |
| VALGANCICLOVIR HYDROCHLORIDE Valganciclovir Hydrochloride | — Medicare Part D | — | — | — |
| Deferasirox Oral Granules | — Medicare Part D | — | — | — |
| SODIUM NITROPRUSSIDE Sodium Nitroprusside | — Medicare Part D | — | — | — |
| Darunavir Darunavir | — Medicare Part D | — | — | — |
| Viokace Pancrelipase | — Medicare Part D | — | — | — |
| Carbon Dioxide/Oxygen 5/95 Carbon Dioxide/Oxygen 5/95 | — Medicare Part D | — | — | — |