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 |
|---|---|---|---|---|
| Duopa Carbidopa and Levodopa | — Medicare Part D | — | — | — |
| Pantoprazole Sodium PANTOPRAZOLE | — Medicare Part D | — | — | — |
| AMOXICILLIN AND CLAVULANATE POTASSIUM Amoxicillin and Clavulanate Potassium | — Medicare Part D | — | — | — |
| FAMOTIDINE FAMOTIDINE | — Medicare Part D | — | — | — |
| Tacrolimus Tacrolimus | — Medicare Part D | — | — | — |
| Amoxil Amoxicillin Oral Susp | — Medicare Part D | — | — | — |
| FELODIPINE Felodipine | — Medicare Part D | — | — | — |
| Lialda mesalamine | — Medicare Part D | — | — | — |
| OXYBUTYNIN CHLORIDE OXYBUTYNIN CHLORIDE | — Medicare Part D | — | — | — |
| Sylvant Siltuximab | — Medicare Part D | — | — | — |
| BETAMETHASONE VALERATE Betamethasone Valerate | — Medicare Part D | — | — | — |
| FAMCICLOVIR Famciclovir | — Medicare Part D | — | — | — |
| Polifleks 0.9% Isotonic Sodium Chloride | — Medicare Part D | — | — | — |
| Insulin Aspart insulin aspart | — Medicare Part D | Yes | — | — |
| Calcitrene Calcipotriene | — Medicare Part D | — | — | — |
| Micardis telmisartan | — Medicare Part D | — | — | — |
| Ojjaara Momelotinib | — Medicare Part D | — | — | — |
| Marcaine BUPIVACAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Livalo pitavastatin calcium | — Medicare Part D | — | — | — |
| Tembexa Brincidofovir | — Medicare Part D | — | — | — |
| PERAMPANEL Perampanel | — Medicare Part D | — | — | — |
| FLUOROURACIL FLUOROURACIL | — Medicare Part D | — | — | — |
| BENZONATATE Benzonatate | — Medicare Part D | — | — | — |
| Hamamelis virginiana HAMAMELIS VIRGINIANA ROOT BARK/STEM BARK | — Medicare Part D | — | — | — |
| Levothyroxine Sodium Levothyroxine Sodium | — Medicare Part D | — | — | — |
| GaviLyte-H and Bisacodyl Polyethylene Glycol 3350, Sodium Chloride, Sodium Bicarbonate, Potassium Chloride and Bisacodyl Delayed-release Tablet | — Medicare Part D | — | — | — |
| Zetia Ezetimibe | — Medicare Part D | — | — | — |
| LIDOCAINE Lidocaine HCl, Menthol | — Medicare Part D | — | — | — |
| BOSULIF Bosutinib | — Medicare Part D | — | — | — |
| Auranofin auranofin | — Medicare Part D | — | — | — |
| LOSARTAN POTASSIUM 25 mg LOSARTAN POTASSIUM | — Medicare Part D | — | — | — |
| Erzofri extended-release paliperidone palmitate | — Medicare Part D | Yes | — | — |
| Psorizide Forte Nickel Sulfate, Potassium Bromide, and Fumaric Acid | — Medicare Part D | — | — | — |
| Zanaflex tizanidine hydrochloride | — Medicare Part D | — | — | — |
| Tobramycin Inhalation Solution Pak | — Medicare Part D | — | — | — |
| VENLAFAXINE HYDROCHLORIDE VENLAFAXINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE | — Medicare Part D | — | — | — |
| Gelato APF Sodium Fluoride | — Medicare Part D | — | — | — |
| EYLEA aflibercept | — Medicare Part D | — | — | — |
| Epinephrine Professional Epinephrine and Isopropyl Alcohol | — Medicare Part D | — | — | — |
| Varibar Honey barium sulfate | — Medicare Part D | — | — | — |
| IPRATROPIUM BROMIDE AND ALBUTEROL SULFATE Ipratropium Bromide and Albuterol Sulfate | — Medicare Part D | — | — | — |
| Carbon Dioxide Oxygen Mixture 5/95 Carbon Dioxide Oxygen Mixture 5/95 | — Medicare Part D | — | — | — |
| PREGABALIN Pregabalin | — Medicare Part D | — | — | — |
| ITRACONAZOLE Itraconazole | — Medicare Part D | — | — | — |
| Diltiazem Hydrochloride diltiazem hydrochloride | — Medicare Part D | — | — | — |
| UDENYCA pegfilgrastim-cbqv | — Medicare Part D | Yes | — | — |
| Cerezyme IMIGLUCERASE | — Medicare Part D | — | — | — |
| LAMOTRIGINE Kit, LAMOTRIGINE | — Medicare Part D | — | — | — |
| Rybrevant Faspro AMIVANTAMAB and HYALURONIDASE-lpuj (HUMAN RECOMBINANT) | — Medicare Part D | — | — | — |