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 |
|---|---|---|---|---|
| CLONIDINE HYDROCHLORIDE clonidine hydrochloride | — Medicare Part D | — | — | — |
| Carbon Dioxide Air Carbon Dioxide Air Mixture | — Medicare Part D | — | — | — |
| FLUDROCORTISONE ACETATE FLUDROCORTISONE ACETATE | — Medicare Part D | — | — | — |
| ELIQUIS apixaban | — Medicare Part D | — | — | — |
| ZILBRYSQ zilucoplan | — Medicare Part D | Yes | — | — |
| Uro-MP Methenamine, Sodium Phosphate, Monobasic, Anhydrous, Phenyl Salicylate, Methylene Blue and Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| Crotalus cascavella CROTALUS DURISSUS TERRIFICUS VENOM | — Medicare Part D | — | — | — |
| Memantine and Donepezil Memantine and Donepezil | — Medicare Part D | — | — | — |
| ESTRADIOL VAGINAL INSERTS estradiol | — Medicare Part D | — | — | — |
| MOXIFLOXACIN MOXIFLOXACIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Urea Cream 41% Urea | — Medicare Part D | — | — | — |
| Sulindac sulindac | — Medicare Part D | — | — | — |
| Jentadueto XR linagliptin and metformin hydrochloride | — Medicare Part D | — | — | — |
| Veklury remdesivir | — Medicare Part D | — | — | — |
| Besivance Besifloxacin | — Medicare Part D | Yes | — | — |
| Lidocaine Hydrochloride and Hydrocortisone Acetate Lidocaine Hydrochloride and Hydrocortisone Acetate | — Medicare Part D | — | — | — |
| Cleviprex clevidipine | — Medicare Part D | — | — | — |
| AMZEEQ Minocycline | — Medicare Part D | — | — | — |
| Scandonest 3% Plain Mepivacaine Hydrochloride | — Medicare Part D | — | — | — |
| Matervia ascorbic acid, cholecalciferol, thiamine, pyridoxal-5-phosphate, folic acid, methylcobalamin, calcium citrate, iron, iodine | — Medicare Part D | — | — | — |
| VEOZAH fezolinetant | — Medicare Part D | — | — | — |
| TIZANIDINE HYDROCHLORIDE tizanidine hydrochloride | — Medicare Part D | — | — | — |
| DICLOXACILLIN SODIUM Dicloxacillin Sodium | — Medicare Part D | — | — | — |
| ANTISEPTIC SKIN CLEANSER Chlorhexidine Gluconate 4% | — Medicare Part D | — | — | — |
| Pazopanib pazopanib hydrochloride | — Medicare Part D | — | — | — |
| AMANTADINE HYDROCHLORIDE Amantadine Hydrochloride | — Medicare Part D | — | — | — |
| LIDOCAINE HYDROCHLORIDE Lidocaine Hydrochloride | — Medicare Part D | — | — | — |
| SOLIRIS ECULIZUMAB | — Medicare Part D | — | — | — |
| SUNITINIB MALATE Sunitinib malate | — Medicare Part D | — | — | — |
| Pyridostigmine Bromide PYRIDOSTIGMINE BROMIDE | — Medicare Part D | — | — | — |
| Adapalene Gel USP, 0.3% | — Medicare Part D | — | — | — |
| DIPHENOXYLATE HYDROCHLORIDE AND ATROPINE SULFATE diphenoxylate hydrochloride and atropine sulfate | — Medicare Part D | — | — | — |
| AIR COMPRESSED AIR COMPRESSED | — Medicare Part D | — | — | — |
| Kodatef tafenoquine | — Medicare Part D | — | — | — |
| FROVATRIPTAN Frovatriptan succinate | — Medicare Part D | — | — | — |
| Absinthium Phytolacca Decandra, Arsenicum Iodatum, Agraphis Nutans, Apium Graveolens, Eriodictyon Californicum, Allium Sativum, Erigeron Canadensis, Euonymus Atropurpureus, Aconitum Lycoctonum, Aethiops Antimonialis, Euonymus Europaeus, Absinthium, Apis Mellifica, Causticum, Sanguinaria Canadensis, Uva Ursi, Capsicum Annuum | — Medicare Part D | — | — | — |
| VIGPODER vigabatrin | — Medicare Part D | — | — | — |
| DOXEPIN doxepin hydrochloride | — Medicare Part D | — | — | — |
| INTROVALE Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| TERUFLEX Blood with Diversion Blood Sampling Arm Anticoagulant CPD with OPTISOL Red Cell Preservative for Collection of 450mL of Blood | — Medicare Part D | — | — | — |
| Oxacillin Oxacillin Sodium | — Medicare Part D | — | — | — |
| BRIMONIDINE TARTRATE and TIMOLOL MALEATE Brimonidine Tartrate and Timolol Maleate | — Medicare Part D | — | — | — |
| RIVAROXABAN Rivaroxaban | — Medicare Part D | — | — | — |
| Dihydroergotamine Mesylate Dihydroergotamine mesylate | — Medicare Part D | — | — | — |
| LEVULAN KERASTICK aminolevulinic acid hydrochloride | — Medicare Part D | — | — | — |
| EPIOXA CROSS-LINKING riboflavin 5-phosphate ophthalmic | — Medicare Part D | — | — | — |
| ACD A Citric Acid Monohydrate, Dextrose Monohydrate, and Trisodium Citrate Dihydrate | — Medicare Part D | — | — | — |
| Mexiletine Hydrochloride Mexiletine hydrochloride | — Medicare Part D | — | — | — |
| Sevelamer Hydrochloride Sevelamer Hydrochloride | — Medicare Part D | — | — | — |
| Clindamycin HCL Clindamycin HCL | — Medicare Part D | — | — | — |