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 |
|---|---|---|---|---|
| Dyural LM Kit Methylprednisolone Acetate, Lidocaine Hydrochloride, Bupivacaine Hydrochloride, Povidine Iodine, Isopropyl Alcohol | — Medicare Part D | — | — | — |
| Bismuth subcitrate potassium, Metronidazole, Tetracycline hydrochloride Bismuth subcitrate potassium, Metronidazole, Tetracycline hydrochloride | — Medicare Part D | — | — | — |
| AZACITIDINE AZACITIDINE | — Medicare Part D | — | — | — |
| Diprivan PROPOFOL | — Medicare Part D | — | — | — |
| Rilpivirine Rilpivirine | — Medicare Part D | Yes | — | — |
| LOJAIMIESS levonorgestrel/ethinyl estradiol and ethinyl estradiol | — Medicare Part D | — | — | — |
| VERAPAMIL HCI VERAPAMIL HCI | — Medicare Part D | — | — | — |
| Droxidopa Droxidopa | — Medicare Part D | — | — | — |
| Diltiazem Hydrochloride EXTENDED RELEASE Diltiazem Hydrochloride | — Medicare Part D | — | — | — |
| Methenamine Mandelate Methenamine Mandelate | — Medicare Part D | — | — | — |
| OXYBUTYNIN CHLORIDE OXYBUTYNIN CHLORIDE | — Medicare Part D | — | — | — |
| Naratriptan Naratriptan | — Medicare Part D | — | — | — |
| Avanafil Avanafil | — Medicare Part D | — | — | — |
| Imlygic talimogene laherparepvec | — Medicare Part D | — | — | — |
| ATROPINE SULFATE Atropine Sulfate | — Medicare Part D | — | — | — |
| FLUOCINONIDE FLUOCINONIDE | — Medicare Part D | — | — | — |
| SODIUM IODIDE I 123 Sodium Iodide I 123 | — Medicare Part D | — | — | — |
| Tranylcypromine Sulfate Tranylcypromine sulfate | — Medicare Part D | — | — | — |
| Standardized Redtop Grass, Standardized Sweet Vernal Grass, Standardized Bermuda Grass, Standardized Orchard Grass, Standardized Meadow Fescue Grass, Standardized Perennial Rye Grass, Standardized Timothy Grass, Standardized Kentucky Blue (June) Grass | — Medicare Part D | — | — | — |
| Cardizem LA Diltiazem Hydrochloride | — Medicare Part D | — | — | — |
| IVRA melphalan HCl | — Medicare Part D | — | — | — |
| LISDEXAMFETAMINE DIMESYLATE Lisdexamfetamine | — Medicare Part D | — | — | — |
| Ga-68-DOTATOC EDOTREOTIDE GALLIUM GA-68 | — Medicare Part D | — | — | — |
| Neomycin Sulfate Bacitracin Zinc, Neomycin Sulfate, Polymyxin B Sulfate, and Pramoxine Hydrochloride | — Medicare Part D | — | — | — |
| Ritalin methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Prograf Tacrolimus | — Medicare Part D | — | — | — |
| Naproxen Oral Suspension Naproxen | — Medicare Part D | — | — | — |
| MITIGARE Colchicine | — Medicare Part D | — | — | — |
| TROMETHAMINE Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| Dactinomycin DACTINOMYCIN | — Medicare Part D | — | — | — |
| Jardiance Empagliflozin | — Medicare Part D | — | — | — |
| MEPSEVII vestronidase alfa | — Medicare Part D | — | — | — |
| Tetracycline Hydrochloride Tetracycline Hydrochloride | — Medicare Part D | — | — | — |
| Carbon Dioxide-Oxygen Mixture Carbon Dioxide-Oxygen Mixture | — Medicare Part D | — | — | — |
| Sodium acetate anhydrous Sodium acetate anhydrous | — Medicare Part D | — | — | — |
| Methylene Blue Methylene Blue | — Medicare Part D | — | — | — |
| INOMAX nitric oxide | — Medicare Part D | — | — | — |
| Daunorubicin Hydrochloride Daunorubicin Hydrochloride | — Medicare Part D | — | — | — |
| HUMATROPE Somatropin | — Medicare Part D | Yes | — | — |
| IQ Dental Mepivacaine Mepivacaine Hydrochloride | — Medicare Part D | — | — | — |
| Zonalon doxepin hydrochloride | — Medicare Part D | — | — | — |
| ARSENIC TRIOXIDE ARSENIC TRIOXIDE | — Medicare Part D | — | — | — |
| ANGIOTENSIN II angiotensin II | — Medicare Part D | — | — | — |
| PHYSOSTIGMINE SALICYLATE physostigmine salicylate | — Medicare Part D | — | — | — |
| ISOTRETINOIN isotretinoin | — Medicare Part D | — | — | — |
| BUTAL/APAP/CAFFEINE BUTAL/APAP/CAFFEINE | — Medicare Part D | — | — | — |
| KOURZEQ Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| METHADOSE DISPERSIBLE, METHADONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 9.8% Sulfur 4.8% Cleanser Sodium Sulfacetamide 9.8% Sulfur 4.8% | — Medicare Part D | — | — | — |
| Welchol colesevelam hydrochloride | — Medicare Part D | — | — | — |