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 |
|---|---|---|---|---|
| Tamiflu oseltamivir phosphate | — Medicare Part D | — | — | — |
| Sovaldi SOFOSBUVIR | — Medicare Part D | — | — | — |
| EDECRIN ethacrynic acid | — Medicare Part D | — | — | — |
| VARENICLINE TARTRATE Varenicline Tartrate | — Medicare Part D | — | — | — |
| Gadoterate Meglumine gadoterate meglumine | — Medicare Part D | — | — | — |
| Tigan Trimethobenzamide Hydrochloride | — Medicare Part D | — | — | — |
| emtricitabine EMTRICITABINE | — Medicare Part D | — | — | — |
| GLEOLAN AMINOLEVULINIC ACID HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Olopatadine Hydrochloride Olopatadine Hydrochloride | — Medicare Part D | — | — | — |
| PAIN RELIEF Pain Relief | — Medicare Part D | — | — | — |
| PRASUGREL prasugrel hydrochloride | — Medicare Part D | — | — | — |
| VYKOURA leucovorin calcium | — Medicare Part D | — | — | — |
| Mitoxantrone Mitoxantrone | — Medicare Part D | — | — | — |
| Lutathera Lutetium Lu 177 dotatate | — Medicare Part D | — | — | — |
| VARDENAFIL HYDROCHLORIDE VARDENAFIL HYDROCHLORIDE | — Medicare Part D | — | — | — |
| GALZIN Zinc Acetate | — Medicare Part D | — | — | — |
| VALSARTAN valsartan | — Medicare Part D | — | — | — |
| Ketalar ketamine hydrochloride | — Medicare Part D | — | — | — |
| DEHYDRATED ALCOHOL ALCOHOL | — Medicare Part D | — | — | — |
| Dutasteride and Tamsulosin Hydrochloride Dutasteride and Tamsulosin Hydrochloride | — Medicare Part D | — | — | — |
| Cardamyst etripamil | — Medicare Part D | — | — | — |
| Pyridostigmine Bromide PYRIDOSTIGMINE BROMIDE | — Medicare Part D | — | — | — |
| Meropenem and Sodium Chloride Meropenem and Sodium Chloride | — Medicare Part D | — | — | — |
| Chronagesic Alpha-Lipoicum Acidum, Apiolum, Arnica Montana, Cartilago Suis, Cinnamomum, Dulcamara, Funiculus Umbilicalis Suis, Nadidum, Natrum Oxalaceticum, Pantothenic Acid, Placenta Totalis Suis, Piper Nigrum, Rhus Tox, Sanguinaria Canadensis, Sulphur, Silicea, Symphytum Officinale, Thuja Occidentalis | — Medicare Part D | — | — | — |
| LEVETIRACETAM Levetiracetam | — Medicare Part D | — | — | — |
| PHYTONADIONE Phytonadione | — Medicare Part D | — | — | — |
| BETAMETHASONE DIPROPIONATE Betamethasone dipropionate | — Medicare Part D | — | — | — |
| GIMOTI METOCLOPRAMIDE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| ZURZUVAE zuranolone | — Medicare Part D | — | — | — |
| CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE | — Medicare Part D | — | — | — |
| Lisinopril/HCTZ Lisinopril/HCTZ | — Medicare Part D | — | — | — |
| Finazol Ferrous Fumarate, Folate | — Medicare Part D | — | — | — |
| Dyural L Kit Methylprednisolone Acetate, Lidocaine Hydrochloride, Povidine Iodine, Isopropyl Alcohol | — Medicare Part D | — | — | — |
| CLARINEX-D 12 HOUR desloratadine and pseudoephedrine sulfate | — Medicare Part D | — | — | — |
| Vizamyl Flutemetamol F-18 | — Medicare Part D | — | — | — |
| ONYDA XR Clonidine hydrochloride | — Medicare Part D | — | — | — |
| PROPRANOLOL HYDROCHLORIDE propranolol hydrochloride | — Medicare Part D | — | — | — |
| Kyzatrex TESTOSTERONE UNDECANOATE | — Medicare Part D | — | — | — |
| Eucrisa crisaborole | — Medicare Part D | — | — | — |
| Depakote ER Divalproex Sodium | — Medicare Part D | — | — | — |
| MIDODRINE HYDROCHLORIDE Midodrine Hydrochloride | — Medicare Part D | — | — | — |
| Tizanidne hydrochloride Tizanidne Hydrochloride | — Medicare Part D | — | — | — |
| LACTATED RINGERS SODIUM CHLORIDE, SODIUM LACTATE, POTASSIUM CHLORIDE, and CALCIUM CHLORIDE | — Medicare Part D | — | — | — |
| ROFLUMILAST roflumilast | — Medicare Part D | — | — | — |
| EstroGel estradiol | — Medicare Part D | — | — | — |
| IBUPROFEN ibuprofen | — Medicare Part D | — | — | — |
| Stelara ustekinumab | — Medicare Part D | — | — | — |
| CEREBYX Fosphenytoin Sodium | — Medicare Part D | — | — | — |
| ORPHENADRINE CITRATE Orphenadrine citrate | — Medicare Part D | — | — | — |
| RIVAROXABAN Rivaroxaban | — Medicare Part D | — | — | — |