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 |
|---|---|---|---|---|
| Mesalamine Rectal Mesalamine | — Medicare Part D | — | — | — |
| Alclometasone Dipropionate Alclometasone Dipropionate | — Medicare Part D | — | — | — |
| IMPAVIDO miltefosine | — Medicare Part D | — | — | — |
| BONDLIDO lidocaine | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 9.7/90.3 Oxygen/Nitrogen 9.7/90.3 | — Medicare Part D | — | — | — |
| Acebutolol Hydrochloride Acebutolol Hydrochloride | — Medicare Part D | — | — | — |
| PERMETHRIN PERMETHRIN | — Medicare Part D | — | — | — |
| Duramorph morphine sulfate | — Medicare Part D | — | — | — |
| AMJEVITA adalimumab-atto | — Medicare Part D | Yes | — | — |
| LEQEMBI, LECANEMAB AUTOINJECTOR | — Medicare Part D | — | — | — |
| Clonazepam Clonazepam | — Medicare Part D | — | — | — |
| Pfizerpen penicillin G potassium | — Medicare Part D | — | — | — |
| IMFINZI Durvalumab | — Medicare Part D | — | — | — |
| REZDIFFRA Resmetirom | — Medicare Part D | — | — | — |
| VennGel II diclofenac sodium, isopropyl alcohol | — Medicare Part D | — | — | — |
| Sular nisoldipine | — Medicare Part D | — | — | — |
| Bloxiverz Neostigmine Methylsulfate | — Medicare Part D | — | — | — |
| ZIEXTENZO pegfilgrastim-bmez | — Medicare Part D | Yes | — | — |
| SILDENAFIL CITRATE SILDENAFIL CITRATE | — Medicare Part D | — | — | — |
| Fomepizole fomepizole | — Medicare Part D | — | — | — |
| Terrell Isoflurane | — Medicare Part D | — | — | — |
| Cosentyx secukinumab | — Medicare Part D | Yes | — | — |
| POLYMYXIN B Polymyxin B sulfate | — Medicare Part D | — | — | — |
| BELSOMRA suvorexant | — Medicare Part D | — | — | — |
| Fexmid Cyclobenzaprine Hydrochloride | — Medicare Part D | — | — | — |
| Azurette desogestrel/ethinyl estradiol and ethinyl estradiol | — Medicare Part D | — | — | — |
| ANCOBON Flucytosine | — Medicare Part D | — | — | — |
| MIOSTAT carbachol | — Medicare Part D | — | — | — |
| METHOTREXATE Methotrexate | — Medicare Part D | — | — | — |
| Etravirine etravirine | — Medicare Part D | — | — | — |
| Ozempic semaglutide | — Medicare Part D | Yes | — | — |
| CLINDAMYCIN AND BENZOYL PEROXIDE clindamycin and benzoyl peroxide | — Medicare Part D | — | — | — |
| ANDEMBRY Garadacimab | — Medicare Part D | Yes | — | — |
| CIMETIDINE HYDROCHLORIDE CIMETIDINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Desogestrel and Ethinyl Estradiol Desogestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| AGAMREE VAMOROLONE | — Medicare Part D | Yes | — | — |
| Baxdela delafloxacin meglumine | — Medicare Part D | Yes | — | — |
| Gonal-f RFF Redi-ject FOLLITROPIN | — Medicare Part D | — | — | — |
| VARDENAFIL VARDENAFIL HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Cystografin diatrizoate meglumine | — Medicare Part D | — | — | — |
| Hydrocortisone Acetate, Iodoquinol Hydrocortisone Acetate, Iodoquinol | — Medicare Part D | — | — | — |
| Fycompa perampanel | — Medicare Part D | — | — | — |
| EUTHYROX levothyroxine sodium | — Medicare Part D | — | — | — |
| Helium/Oxygen Mixture 80/20 Helium/Oxygen Mixture 80/20 | — Medicare Part D | — | — | — |
| Ketorocaine L Kit Ketorolac Tromethamine, Lidocaine Hydrochloride, Povidine Iodine | — Medicare Part D | — | — | — |
| PROPYLTHIOURACIL Propylthiouracil | — Medicare Part D | — | — | — |
| Trulicity Dulaglutide | — Medicare Part D | Yes | — | — |
| Pentoxifylline Pentoxifylline | — Medicare Part D | — | — | — |
| Levonorgetsrel and Ethinyl Estradiol Levonorgetsrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Saxagliptin and Metformin Hydrochloride SAXAGLIPTIN AND METFORMIN HYDROCHLORIDE | — Medicare Part D | — | — | — |