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 |
|---|---|---|---|---|
| Dilantin Extended Phenytoin Sodium | — Medicare Part D | — | — | — |
| Selenium Sulfide SELENIUM SULFIDE | — Medicare Part D | — | — | — |
| Asclera POLIDOCANOL | — Medicare Part D | — | — | — |
| SOGROYA somapacitan-beco | — Medicare Part D | Yes | — | — |
| VERSACLOZ Clozapine | — Medicare Part D | — | — | — |
| DOFETILIDE Dofetilide | — Medicare Part D | — | — | — |
| PAPZIMEOS zopapogene imadenovec | — Medicare Part D | — | — | — |
| Standardized Cat Hair Cat Hair | — Medicare Part D | — | — | — |
| Sodium Fluoride Chewable Sodium Fluoride | — Medicare Part D | — | — | — |
| FORANE isoflurane | — Medicare Part D | — | — | — |
| VENLAFAXINE venlafaxine hydrochloride | — Medicare Part D | — | — | — |
| MONJUVI Tafasitamab-cxix | — Medicare Part D | — | — | — |
| Spiriva HandiHaler TIOTROPIUM BROMIDE | — Medicare Part D | — | — | — |
| Fluvastatin Sodium fluvastatin sodium | — Medicare Part D | — | — | — |
| Nystatin NYSTATIN | — Medicare Part D | — | — | — |
| Clarithromycin Clarithromycin | — Medicare Part D | — | — | — |
| ONEXTON Clindamycin Phosphate and Benzoyl Peroxide | — Medicare Part D | — | — | — |
| NYPOZI txid filgrastim-txid | — Medicare Part D | — | — | — |
| Wera norethindrone and ethinyl estradiol | — Medicare Part D | — | — | — |
| FORZINITY Elamipretide Hydrochloride | — Medicare Part D | Yes | — | — |
| Oxaprozin Oxaprozin | — Medicare Part D | — | — | — |
| NYSTATIN AND TRIAMCINOLONE ACETONIDE nystatin and triamcinolone acetonide | — Medicare Part D | — | — | — |
| LUIZZA 1/20 norethindrone acetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| BLINCYTO blinatumomab | — Medicare Part D | — | — | — |
| CUVRIOR TRIENTINE TETRAHYDROCHLORIDE | — Medicare Part D | — | — | — |
| Ampicillin Ampicillin | — Medicare Part D | — | — | — |
| Avzivi tnjn, Avzivi | — Medicare Part D | — | — | — |
| Prunus spinosa PRUNUS SPINOSA FLOWER BUD | — Medicare Part D | — | — | — |
| Testim testosterone | — Medicare Part D | — | — | — |
| Cefpodoxime Proxetil Cefpodoxime Proxetil | — Medicare Part D | — | — | — |
| Mometasone Furoate Mometasone Furoate | — Medicare Part D | — | — | — |
| QUETIAPINE FUMARATE Quetiapine Fumarate | — Medicare Part D | — | — | — |
| Combivent Respimat ipratropium bromide and albuterol | — Medicare Part D | — | — | — |
| Hydrocodone/APAP Hydrocodone/APAP | — Medicare Part D | — | — | — |
| HERZUMA TRASTUZUMAB | — Medicare Part D | — | — | — |
| Diltiazem Hydrochloride Extended-Release Diltiazem Hydrochloride | — Medicare Part D | — | — | — |
| Itovebi Inavolisib | — Medicare Part D | — | — | — |
| CombiPatch (estradiol/norethindrone acetate transdermal system) estradiol/norethindrone acetate transdermal system | — Medicare Part D | — | — | — |
| Metoprolol Tartrate Metoprolol tartrate | — Medicare Part D | — | — | — |
| ENBREL etanercept | — Medicare Part D | Yes | — | — |
| nu-derm system normal-dry skin transformation Hydroquinone, Octisalate and Zinc Oxide | — Medicare Part D | — | — | — |
| TESTOSTERONE CYPIONATE Testosterone Cypionate | — Medicare Part D | — | — | — |
| Cyclobenzaprine Hydrochloride CYCLOBENZAPRINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Lidotral Two Percent Lidocaine Hydrochloride | — Medicare Part D | — | — | — |
| Transderm Scop Scopolamine | — Medicare Part D | — | — | — |
| DEXTENZA dexamethasone | — Medicare Part D | — | — | — |
| Orthaphen Diclofenac Sodium and Menthol, Methyl salicylate | — Medicare Part D | — | — | — |
| XYLOCAINE MPF LIDOCAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| METFORMIN HYDROCHLORIDE metformin hydrochloride | — Medicare Part D | — | — | — |
| Vyepti eptinezumab-jjmr | — Medicare Part D | — | — | — |