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 |
|---|---|---|---|---|
| Novarel gonadotrophin, chorionic | — Medicare Part D | — | — | — |
| Sodium Fluoride 1.1% | — Medicare Part D | — | — | — |
| Calcitriol Calcitriol | — Medicare Part D | — | — | — |
| DABIGATRAN ETEXILATE dabigatran etexilate | — Medicare Part D | — | — | — |
| Neostigmine Methylsulfate neostigmine methylsulfate | — Medicare Part D | — | — | — |
| EVEROLIMUS Everolimus | — Medicare Part D | — | — | — |
| HYDROCORTISONE VALERATE Hydrocortisone Valerate | — Medicare Part D | — | — | — |
| Bacitracin Bacitracin | — Medicare Part D | — | — | — |
| Metformin metformin hydrochloride | — Medicare Part D | — | — | — |
| Qsymia phentermine and topiramate | — Medicare Part D | — | — | — |
| Clematis erecta CLEMATIS ERECTA | — Medicare Part D | — | — | — |
| Urea 41% Urea | — Medicare Part D | — | — | — |
| Lithium Carbonate lithium carbonate | — Medicare Part D | — | — | — |
| INFLECTRA infliximab-dyyb | — Medicare Part D | — | — | — |
| BEIZRAY Docetaxel | — Medicare Part D | — | — | — |
| KEYTRUDA pembrolizumab | — Medicare Part D | — | — | — |
| Clarinex Desloratadine | — Medicare Part D | — | — | — |
| Oxymorphone Hydrochloride Oxymorphone hydrochloride | — Medicare Part D | — | — | — |
| Spironolactone Spironolactone | — Medicare Part D | — | — | — |
| EYDENZELT boav aflibercept | — Medicare Part D | — | — | — |
| Buspirone Hydrochloride buspirone hydrochloride | — Medicare Part D | — | — | — |
| Chlorhexidine Gluconate 0.12% Oral Rinse | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 26/74 Oxygen/Nitrogen 26/74 | — Medicare Part D | — | — | — |
| Zoloft sertraline hydrochloride | — Medicare Part D | — | — | — |
| PAPAVERINE HYDROCHLORIDE Papaverine Hydrochloride | — Medicare Part D | — | — | — |
| BROMFENAC Bromfenac | — Medicare Part D | — | — | — |
| Cryselle Norgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| CYANOCOBALAMINE cyanocobalamine injection | — Medicare Part D | — | — | — |
| SPEVIGO spesolimab-sbzo | — Medicare Part D | Yes | — | — |
| Topotecan Topotecan Hydrochloride | — Medicare Part D | — | — | — |
| Methazolamide Methazolamide | — Medicare Part D | — | — | — |
| ELELYSO Taliglucerase alfa | — Medicare Part D | — | — | — |
| Cathflo Activase Alteplase | — Medicare Part D | — | — | — |
| Coly-Mycin M colistimethate | — Medicare Part D | — | — | — |
| OLMESARTAN MEDOXOMIL, AMLODIPINE and HYDROCHLOROTHIAZIDE Olmesartan medoxomil, amlodipine and hydrochlorothiazide | — Medicare Part D | — | — | — |
| SUTAB sodium sulfate, magnesium sulfate, and potassium chloride | — Medicare Part D | — | — | — |
| Sodium Sulfate, Potassium Sulfate and Magnesium Sulfate Oral Sodium Sulfate, Potassium Sulfate and Magnesium Sulfate | — Medicare Part D | — | — | — |
| Nitrogen, Oxygen Nitrogen, Oxygen | — Medicare Part D | — | — | — |
| Syphilinum TREPONEMIC SKIN CANKER HUMAN | — Medicare Part D | — | — | — |
| NOREPINEPHRINE BITARTRATE IN SODIUM CHLORIDE NOREPINEPHRINE BITARTRATE | — Medicare Part D | — | — | — |
| Valproic Valproic Acid | — Medicare Part D | — | — | — |
| HYDROCORTISONE VALERATE Hydrocortisone Valerate | — Medicare Part D | — | — | — |
| ZARXIO filgrastim-sndz | — Medicare Part D | Yes | — | — |
| DANYELZA Naxitamab | — Medicare Part D | — | — | — |
| PROPRANOLOL propranolol hydrochloride | — Medicare Part D | — | — | — |
| Ontruzant trastuzumab | — Medicare Part D | — | — | — |
| AMLODIPINE BESYLATE 10 mg, AMLODIPINE BESYLATE 2.5 mg, AMLODIPINE BESYLATE 5 mg | — Medicare Part D | — | — | — |
| PCXX NEUTRAL RNS GRAPE FLUORIDE TREATMENT | — Medicare Part D | — | — | — |
| Lopinavir and Ritonavir Lopinavir and Ritonavir | — Medicare Part D | — | — | — |
| Desvenlafaxine ER Desvenlafaxine ER | — Medicare Part D | — | — | — |