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 |
|---|---|---|---|---|
| Major Oral Rinse | — Medicare Part D | — | — | — |
| Davimet with Iron Iron, Folate | — Medicare Part D | — | — | — |
| CETIRIZINE HYDROCHLORIDE Cetirizine Hydrochloride | — Medicare Part D | — | — | — |
| NYLIA 7/7/7 Norethindrone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Bupivacaine Spinal BUPIVACAINE HYDROCHLORIDE IN DEXTROSE | — Medicare Part D | — | — | — |
| Erlotinib Hydrochloride Erlotinib Hydrochloride | — Medicare Part D | — | — | — |
| Irinotecan Hydrochloride 100 mg/5 mL | — Medicare Part D | — | — | — |
| Adderall Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate | — Medicare Part D | — | — | — |
| KLOR-CON M potassium chloride | — Medicare Part D | — | — | — |
| JAYTHARI Oral Suspension Deflazacort | — Medicare Part D | — | — | — |
| Metformin hydrochloride, Metformin hydrochloride ER | — Medicare Part D | — | — | — |
| METHOCARBAMOL, Methocarbamol | — Medicare Part D | — | — | — |
| NORETHINDRONE norethindrone acetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Bimzelx bimekizumab | — Medicare Part D | Yes | — | — |
| ONCASPAR Pegaspargase | — Medicare Part D | — | — | — |
| EBGLYSS lebrikizumab-lbkz | — Medicare Part D | Yes | — | — |
| BREZTRI budesonide, glycopyrrolate, and formoterol fumarate | — Medicare Part D | — | — | — |
| Acyclovir suspension acyclovir | — Medicare Part D | — | — | — |
| METHYLPREDNISOLONE ACETATE, Methylprednisolone Acetate | — Medicare Part D | — | — | — |
| Sandimmune cyclosporine | — Medicare Part D | — | — | — |
| EVOMELA Melphalan | — Medicare Part D | — | — | — |
| ISENTRESS RALTEGRAVIR | — Medicare Part D | Yes | — | — |
| Galafold migalastat hydrochloride | — Medicare Part D | — | — | — |
| PRAZIQUANTEL Praziquantel | — Medicare Part D | — | — | — |
| Clobetasol Propionate clobetasol propionate | — Medicare Part D | — | — | — |
| Fluocinolone Acetonide fluocinolone acetonide | — Medicare Part D | — | — | — |
| Pentetate zinc trisodium Pentetate zinc trisodium | — Medicare Part D | — | — | — |
| IMIQUIMOD Imiquimod | — Medicare Part D | — | — | — |
| Turqoz norgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| Methylprednisolone Sodium Succinate methylprednisolone sodium succinate | — Medicare Part D | — | — | — |
| LEVONORGESTREL AND ETHINYL ESTRADIOL levonorgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| Sodium Iodide I 131 Diagnostic Sodium Iodide I 131 | — Medicare Part D | — | — | — |
| Plavix clopidogrel | — Medicare Part D | — | — | — |
| Finzala norethindrone acetate and ethinyl estradiol and ferrous fumarate | — Medicare Part D | — | — | — |
| Capecitabine 150mg Capecitabine | — Medicare Part D | — | — | — |
| PIQRAY alpelisib | — Medicare Part D | — | — | — |
| VPRIV velaglucerase alfa | — Medicare Part D | — | — | — |
| METOPROLOL TARTRATE AND HYDROCHLOROTHIAZIDE metoprolol tartrate and hydrochlorothiazide | — Medicare Part D | — | — | — |
| ITRACONAZOLE Itraconazole | — Medicare Part D | — | — | — |
| Fiasp insulin aspart injection | — Medicare Part D | — | — | — |
| Tybost COBICISTAT | — Medicare Part D | — | — | — |
| CLARISCAN gadoterate meglumine | — Medicare Part D | — | — | — |
| Sevelamer Carbonate SEVELAMER CARBONATE | — Medicare Part D | — | — | — |
| Carbon Dioxide Carbon Dioxide | — Medicare Part D | — | — | — |
| POSLUMA flotufolastat F-18 | — Medicare Part D | — | — | — |
| OXALIPLATIN Oxaliplatin | — Medicare Part D | — | — | — |
| Ngenla somatrogon-ghla | — Medicare Part D | Yes | — | — |
| Norepinephrine Bitartrate Norepinephrine bitartrate | — Medicare Part D | — | — | — |
| LYNKUET elinzanetant | — Medicare Part D | — | — | — |
| Levorphanol Tartrate Levorphanol Tartrate | — Medicare Part D | — | — | — |