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 |
|---|---|---|---|---|
| Topotecan Hydrochloride Topotecan Hydrochloride | — Medicare Part D | — | — | — |
| ERYTHROMYCIN ERYTHROMYCIN | — Medicare Part D | — | — | — |
| PREDNISOLONE ACETATE prednisolone acetate | — Medicare Part D | — | — | — |
| Periogard Alcohol Free Chlorhexidine Gluconate | — Medicare Part D | — | — | — |
| PEMETREXED DIPOTASSIUM pemetrexed dipotassium | — Medicare Part D | — | — | — |
| Amlodipine and Valsartan Amlodipine and valsartan | — Medicare Part D | — | — | — |
| Glipizide Glipizide | — Medicare Part D | — | — | — |
| Difamilast ADQUEY | — Medicare Part D | — | — | — |
| Depo-Estradiol estradiol cypionate | — Medicare Part D | Yes | — | — |
| Diphenhydramine Dextromethorphan HBr, Guaifenesin, Diphenhydramine HCl | — Medicare Part D | — | — | — |
| ZIAGEN abacavir sulfate | — Medicare Part D | — | — | — |
| DEXMEDETOMIDINE Dexmedetomidine HCl | — Medicare Part D | — | — | — |
| ATZUMI DIHYDROERGOTAMINE MESYLATE | — Medicare Part D | — | — | — |
| TRIDERM Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| XALIX SALICYLIC ACID | — Medicare Part D | — | — | — |
| Tracleer bosentan | — Medicare Part D | — | — | — |
| DIPHENOXYLATE HYDROCHLORIDE AND ATROPINE SULFATE diphenoxylate hydrochloride and atropine sulfate | — Medicare Part D | — | — | — |
| Lidocaine 5% Lidocaine 5% | — Medicare Part D | — | — | — |
| CLOTRIMAZOLE Clotrimazole | — Medicare Part D | — | — | — |
| Hydroxyzine HCL Hydroxyzine HCL | — Medicare Part D | — | — | — |
| NU-DERM system NORMAL-oily SKIN TRANSFORMATION TRIAL Hydroquinone, Homosalate, Octisalate, and Zinc Oxide | — Medicare Part D | — | — | — |
| erythromycin topical solution 2% | — Medicare Part D | — | — | — |
| Doxycycline Hyclate doxycycline hyclate | — Medicare Part D | — | — | — |
| Carvedilol Carvedilol | — Medicare Part D | — | — | — |
| rivaroxaban granule rivaroxaban granule | — Medicare Part D | — | — | — |
| Helium/Oxygen Mixture 70/30 Helium/Oxygen Mixture 70/30 | — Medicare Part D | — | — | — |
| Ocrevus ocrelizumab | — Medicare Part D | — | — | — |
| EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE Emtricitabine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| Idamycin PFS idarubicin hydrochloride | — Medicare Part D | — | — | — |
| Jynarque, JYNARQUE | — Medicare Part D | Yes | — | — |
| Mozobil PLERIXAFOR | — Medicare Part D | — | — | — |
| ATROPINE SULFATE Atropine Sulfate | — Medicare Part D | — | — | — |
| Folotyn pralatrexate | — Medicare Part D | — | — | — |
| INVOKAMET, INVOKAMET XR | — Medicare Part D | — | — | — |
| varenicline tartrate, Varenicline tartrate | — Medicare Part D | — | — | — |
| AMIODARONE HYDROCHLORIDE Amiodarone hydrochloride | — Medicare Part D | — | — | — |
| FENTANYL TRANSDERMAL fentanyl transdermal | — Medicare Part D | — | — | — |
| norelgestromin and ethinyl estradiol Norelgestromin and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Tetracaine Hydrochloride Tetracaine Hydrochloride | — Medicare Part D | — | — | — |
| Carvedilol Phosphate CARVEDILOL PHOSPHATE | — Medicare Part D | — | — | — |
| Sodium Chloride Sodium Chloride | — Medicare Part D | — | — | — |
| DESOXIMETASONE Desoximetasone | — Medicare Part D | — | — | — |
| Zolpidem Tartrate zolpidem tartrate | — Medicare Part D | — | — | — |
| Vegzelma bevacizumab-adcd | — Medicare Part D | — | — | — |
| Serostim somatropin | — Medicare Part D | Yes | — | — |
| Xylocaine XYLOCAINE | — Medicare Part D | — | — | — |
| KANUMA Sebelipase alfa | — Medicare Part D | — | — | — |
| Clobetasol Propionate (emollient) clobetasol propionate | — Medicare Part D | — | — | — |
| Calcitonin Salmon Calcitonin Salmon | — Medicare Part D | — | — | — |
| Irinotecan Hydrochloride 40 mg/2 mL | — Medicare Part D | — | — | — |