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 |
|---|---|---|---|---|
| CRYSVITA Burosumab | — Medicare Part D | — | — | — |
| DOPAMINE HCI DOPAMINE HCI | — Medicare Part D | — | — | — |
| ZELBORAF Vemurafenib | — Medicare Part D | — | — | — |
| Hailey 1.5/30 Norethindrone Acetate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Spravato Esketamine Hydrochloride | — Medicare Part D | — | — | — |
| Ohtuvayre ensifentrine | — Medicare Part D | Yes | — | — |
| Amphotericin B Amphotericin B | — Medicare Part D | — | — | — |
| Vitalipid N VITAMIN A PALMITATE, Ergocalciferol, .ALPHA.-TOCOPHEROL, DL-, PHYTONADIONE | — Medicare Part D | — | — | — |
| YONDELIS Trabectedin | — Medicare Part D | — | — | — |
| ROSUVASTATIN CALCIUM Rosuvastatin Calcium | — Medicare Part D | — | — | — |
| NEOMYCIN AND POLYMYXIN B SULFATES AND DEXAMETHASONE Neomycin Sulfate, Polymyxin B Sulfate, and Dexamethasone | — Medicare Part D | — | — | — |
| REZLIDHIA olutasidenib | — Medicare Part D | — | — | — |
| Wentworth Alcohol Free Sodium Fluoride | — Medicare Part D | — | — | — |
| PROCHLORPERAZINE EDISYLATE Prochlorperazine Edisylate | — Medicare Part D | — | — | — |
| LIDOCAINE HYDROCHLORIDE AND DEXTROSE LIDOCAINE HYDROCHLORIDE ANHYDROUS and DEXTROSE MONOHYDRATE | — Medicare Part D | — | — | — |
| Penpulimab kcqx Penpulimab | — Medicare Part D | — | — | — |
| Carnitor levocarnitine | — Medicare Part D | — | — | — |
| PAMELOR nortriptyline hydrochloride | — Medicare Part D | — | — | — |
| Salinocaine salicylic acid and benzocaine | — Medicare Part D | — | — | — |
| NAFCILLIN SODIUM Nafcillin Sodium | — Medicare Part D | — | — | — |
| Klaron sulfacetamide sodium | — Medicare Part D | — | — | — |
| ACETAMINOPHEN AND CODEINE PHOSPHATE acetaminophen and codeine phosphate | — Medicare Part D | — | — | — |
| Tramadol HCL ER Tramadol HCL ER | — Medicare Part D | — | — | — |
| Clindamycin Phosphate 1.2% and Tretinoin 0.025% clindamycin phosphate and tretinoin | — Medicare Part D | — | — | — |
| 7.5% SODIUM BICARBONATE, PEDIATRIC 8.4% SODIUM BICARBONATE | — Medicare Part D | — | — | — |
| Dhivy Carbidopa Levodopa | — Medicare Part D | — | — | — |
| Medroloan SUIK Methylprednisolone Acetate | — Medicare Part D | — | — | — |
| Clobetasol Propionate Cream USP, 0.05% Clobetasol Propionate Cream USP, 0.05% | — Medicare Part D | — | — | — |
| BENLYSTA belimumab | — Medicare Part D | Yes | — | — |
| Doxorubicin Hydrochloride DOXORUBICIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Hyoscyamine Sulfate TAB hyoscyamine sulfate | — Medicare Part D | — | — | — |
| CELEBREX CELECOXIB | — Medicare Part D | — | — | — |
| Fomepizole fomepizole | — Medicare Part D | — | — | — |
| METHADONE HYDROCHLORIDE Methadone Hydrochloride | — Medicare Part D | — | — | — |
| Paroxetine Hydrochloride paroxetine hydrochloride | — Medicare Part D | — | — | — |
| Succinylcholine Chloride Succinylcholine Chloride | — Medicare Part D | — | — | — |
| Depakote Divalproex Sodium | — Medicare Part D | — | — | — |
| Valacyclovir Hydrochloride Valacyclovir Hydrochloride | — Medicare Part D | — | — | — |
| Methylergonovine Maleate Methylergonovine maleate | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE (XL) Bupropion hydrochloride | — Medicare Part D | — | — | — |
| glyburide-metformin hydrochloride glyburide-metformin hydrochloride | — Medicare Part D | — | — | — |
| Topicort Desoximetasone | — Medicare Part D | — | — | — |
| Albendazole 200 mg Albendazole | — Medicare Part D | — | — | — |
| Orapaz Cephalexin, Ibuprofen, Chlorhexidine Gluconate | — Medicare Part D | — | — | — |
| EPIVIR lamivudine | — Medicare Part D | — | — | — |
| Lenalidomide Lenalidomide | — Medicare Part D | — | — | — |
| Doxycycline doxycycline | — Medicare Part D | — | — | — |
| THIAMINE HYDROCHLORIDE Thiamine Hydrochloride | — Medicare Part D | — | — | — |
| Cupric Chloride CUPRIC CHLORIDE | — Medicare Part D | — | — | — |