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 |
|---|---|---|---|---|
| Trandolapril Trandolapril | — Medicare Part D | — | — | — |
| METFORMIN HYDROCHLORIDE metformin hydrochloride | — Medicare Part D | — | — | — |
| Trezix acetaminophen, caffeine, dihydrocodeine bitartrate | — Medicare Part D | — | — | — |
| BRINZOLAMIDE brinzolamide | — Medicare Part D | — | — | — |
| Aliskiren aliskiren hemifumarate | — Medicare Part D | — | — | — |
| IROSPAN 24/6 IRON, FOLIC ACID, VITAMIN/MINERAL SUPPLEMENT | — Medicare Part D | — | — | — |
| Glipizide and Metformin Hydrochloride Glipizide and Metformin Hydrochloride | — Medicare Part D | — | — | — |
| Rayaldee calcifediol | — Medicare Part D | — | — | — |
| MEMBRANEBLUE trypan blue | — Medicare Part D | — | — | — |
| Eletriptan Hydrobromide Eletriptan Hydrobromide | — Medicare Part D | — | — | — |
| Acitretin ACITRETIN | — Medicare Part D | — | — | — |
| Briviact brivaracetam | — Medicare Part D | — | — | — |
| Saxenda liraglutide | — Medicare Part D | — | — | — |
| ASPRUZYO SPRINKLE Ranolazine | — Medicare Part D | — | — | — |
| Scopolamine Transdermal System scopolamine transdermal system | — Medicare Part D | — | — | — |
| Insulin Lispro, Insulin Lispro Junior KwikPen, Insulin Lispro KwikPen | — Medicare Part D | Yes | — | — |
| CLONIDINE HYDROCHLORIDE clonidine hydrochloride | — Medicare Part D | — | — | — |
| AMOXICILLIN AND CLAVULANATE POTASSIUM Amoxicillin and Clavulanate Potassium | — Medicare Part D | — | — | — |
| Modafinil Modafinil | — Medicare Part D | — | — | — |
| Codeine Sulfate codeine sulfate | — Medicare Part D | — | — | — |
| ELTROMBOPAG eltrombopag | — Medicare Part D | — | — | — |
| Ketalar ketamine hydrochloride | — Medicare Part D | — | — | — |
| KEBILIDI eladocagene exuparvovec-tneq | — Medicare Part D | — | — | — |
| Velsipity etrasimod | — Medicare Part D | — | — | — |
| 8.4% SODIUM BICARBONATE 8.4% SODIUM BICARBONATE | — Medicare Part D | — | — | — |
| ZALEPLON Zaleplon | — Medicare Part D | — | — | — |
| Proglycem diazoxide | — Medicare Part D | — | — | — |
| VARENICLINE TARTRATE, VARENICLINE | — Medicare Part D | — | — | — |
| Trulicity Dulaglutide | — Medicare Part D | Yes | — | — |
| Meclizine Hydrocloride Meclizine Hydrocloride | — Medicare Part D | — | — | — |
| Mircera Methoxy polyethylene glycol-epoetin beta | — Medicare Part D | Yes | — | — |
| ZYNRELEF BUPIVACAINE and MELOXICAM | — Medicare Part D | — | — | — |
| Wynzora Calcipotriene and Betamethasone dipropionate | — Medicare Part D | — | — | — |
| TIADYLT ER diltiazem hydrochloride | — Medicare Part D | — | — | — |
| GENOTROPIN somatropin | — Medicare Part D | Yes | — | — |
| Foscavir foscarnet sodium | — Medicare Part D | — | — | — |
| BRIVARACETAM brivaracetam | — Medicare Part D | — | — | — |
| PYQUVI deflazacort | — Medicare Part D | — | — | — |
| Flucytosine Flucytosine | — Medicare Part D | — | — | — |
| PURIXAN Purixan | — Medicare Part D | — | — | — |
| Spironolactone Spironolactone | — Medicare Part D | — | — | — |
| Quinidine Gluconate Quinidine Gluconate | — Medicare Part D | — | — | — |
| Ultomiris ravulizumab | — Medicare Part D | — | — | — |
| Bethanechol Chloride Bethanechol Chloride | — Medicare Part D | — | — | — |
| Nabumetone Nabumetone | — Medicare Part D | — | — | — |
| Trimethoprim sulfate and Polymyxin B sulfate Trimethoprim sulfate and Polymyxin B sulfate | — Medicare Part D | — | — | — |
| FLUOCINONIDE FLUOCINONIDE | — Medicare Part D | — | — | — |
| KADCYLA ADO-TRASTUZUMAB EMTANSINE | — Medicare Part D | — | — | — |
| Klonopin Clonazepam | — Medicare Part D | — | — | — |
| Pentazocine and naloxone Pentazocine hydrochloride and naloxone hydrochloride | — Medicare Part D | — | — | — |