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 |
|---|---|---|---|---|
| Lidotral 3.88 Percent Plus Hydrocortisone 1 Percent Cream Lidocaine HCl, Hydrocortisone Acetate | — Medicare Part D | — | — | — |
| SELZENTRY maraviroc | — Medicare Part D | — | — | — |
| Unithroid levothyroxine sodium | — Medicare Part D | — | — | — |
| CAFFEINE CITRATE caffeine citrate | — Medicare Part D | — | — | — |
| GoLYTELY Polyethylene Glycol 3350, Sodium Sulfate Anhydrous, Sodium Bicarbonate, Sodium Chloride, Potassium Chloride | — Medicare Part D | — | — | — |
| Orquidea norethindrone | — Medicare Part D | — | — | — |
| frovatriptan succinate Frovatriptan Succinate | — Medicare Part D | — | — | — |
| VYLOY ZOLBETUXIMAB | — Medicare Part D | — | — | — |
| Pacerone Amiodarone Hydrochloride | — Medicare Part D | — | — | — |
| VALPROIC ACID Valproic Acid | — Medicare Part D | — | — | — |
| Diclofenac Epolamine Diclofenac Epolamine | — Medicare Part D | — | — | — |
| RISPERDAL, RISPERDAL M-TAB | — Medicare Part D | — | — | — |
| Pruradik Crotamiton | — Medicare Part D | — | — | — |
| Coagadex Coagulation Factor X Human | — Medicare Part D | — | — | — |
| SILVADENE silver sulfadiazine | — Medicare Part D | — | — | — |
| Brompheniramine Maleate, Pseudoephedrine Hydrochloride, and Dextromethorphan Hydrobromide Brompheniramine Maleate, Pseudoephedrine Hydrochloride, and Dextromethorphan Hydrobromide | — Medicare Part D | — | — | — |
| Atenolol 29300-411 Atenolol | — Medicare Part D | — | — | — |
| hydroquinone Hydroquinone | — Medicare Part D | — | — | — |
| Brineura cerliponase alfa | — Medicare Part D | — | — | — |
| ZIPSOR diclofenac potassium | — Medicare Part D | — | — | — |
| Buspirone Hydrochloride buspirone hydrochloride | — Medicare Part D | — | — | — |
| Trazodone HCL Trazodone HCl | — Medicare Part D | — | — | — |
| BESREMi ROPEGINTERFERON ALFA-2B | — Medicare Part D | Yes | — | — |
| Captopril Captopril | — Medicare Part D | — | — | — |
| Edluar Zolpidem Tartrate | — Medicare Part D | — | — | — |
| STRENZA PLUS Moxifloxacin 0.5%, Bromfenac 0.09%, Prednisolone Acetate 1% | — Medicare Part D | — | — | — |
| GAVILYTE-N polyethylene glycol-3350, sodium chloride, potassium chloride and sodium bicarbonate | — Medicare Part D | — | — | — |
| JANUMET XR sitagliptin and metformin hydrochloride | — Medicare Part D | — | — | — |
| LOPREEZA estradiol/norethindrone acetate | — Medicare Part D | — | — | — |
| ESTRACE estradiol | — Medicare Part D | — | — | — |
| DIANEAL LOW CALCIUM WITH DEXTROSE, DIANEAL PD-2 WITH DEXTROSE | — Medicare Part D | — | — | — |
| Mibelas 24 Fe NORETHINDRONE ACETATE, ETHINYL ESTRADIOL AND FERROUS FUMARATE | — Medicare Part D | — | — | — |
| NITYR Nitisinone | — Medicare Part D | — | — | — |
| APTENSIO XR methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Gilotrif afatinib | — Medicare Part D | — | — | — |
| Fluticasone Propionate and Salmeterol DISKUS fluticasone propionate and salmeterol | — Medicare Part D | — | — | — |
| Colchicine Colchicine | — Medicare Part D | — | — | — |
| Irinotecan hydrochloide, Irinotecan hydrochloride | — Medicare Part D | — | — | — |
| PIMTREA desogestrel/ethinyl estradiol and ethinyl estradiol | — Medicare Part D | — | — | — |
| DROSPIRENONE AND ETHINYL ESTRADIOL Drospirenone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| NALOXONE HYDROCHLORIDE Naloxone Hydrochloride | — Medicare Part D | — | — | — |
| HEMANGEOL propranolol hydrochloride | — Medicare Part D | — | — | — |
| JUNEL FE 28 DAY Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| REBIF, REBIF REBIDOSE, Rebif | — Medicare Part D | Yes | — | — |
| Tobradex ST tobramycin / dexamethasone | — Medicare Part D | — | — | — |
| Sodium Sulfate, Potassium Sulfate, and Magnesium Sulfate Bowel Prep kit sodium sulfate anhydrous, potassium sulfate, and magnesium sulfate | — Medicare Part D | — | — | — |
| HULIO adalimumab-fkjp | — Medicare Part D | — | — | — |
| Gadobutrol Gadobutrol | — Medicare Part D | — | — | — |
| Fulvestrant Fulvestrant | — Medicare Part D | — | — | — |
| Diazepam diazepam | — Medicare Part D | — | — | — |