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 |
|---|---|---|---|---|
| YESINTEK ustekinumab | — Medicare Part D | Yes | — | — |
| GLATIRAMER ACETATE Glatiramer Acetate Injection | — Medicare Part D | — | — | — |
| Mycozyl HC Cream Gel Tolnaftate, Hydrocortisone | — Medicare Part D | — | — | — |
| Varithena polidocanol | — Medicare Part D | — | — | — |
| KEPIVANCE palifermin | — Medicare Part D | — | — | — |
| Articadent Articaine hydrochloride and Epinephrine Bitartrate | — Medicare Part D | — | — | — |
| PERPHENAZINE perphenazine | — Medicare Part D | — | — | — |
| Nabumetone 500 mg, Nabumetone 750 mg, Nabumetone 1000 mg | — Medicare Part D | — | — | — |
| Zortress everolimus | — Medicare Part D | — | — | — |
| Vostally ramipril | — Medicare Part D | — | — | — |
| CERIANNA FLUOROESTRADIOL F 18 | — Medicare Part D | — | — | — |
| Clopidogrel Bisulfate clopidogrel bisulfate | — Medicare Part D | — | — | — |
| RANOLAZINE Ranolazine | — Medicare Part D | — | — | — |
| VANFLYTA QUIZARTINIB | — Medicare Part D | — | — | — |
| LURASIDONE HYDROCHLORIDE LURASIDONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| OXYCODONE HYDROCHLORIDE, Oxycodone Hydrochloride | — Medicare Part D | — | — | — |
| POTASSIUM PHOSPHATES Potassium Phosphate, Monobasic Potassium Phosphate, Dibasic | — Medicare Part D | — | — | — |
| Ketamine Hydrochloride ketamine hydrochloride | — Medicare Part D | — | — | — |
| Orphenadrine Citrate ER Orphenadrine Citrate | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 12/88 Oxygen/Nitrogen 12/88 | — Medicare Part D | — | — | — |
| Se-Tan PLUS MULTIVITAMIN/MINERAL | — Medicare Part D | — | — | — |
| DEXEDRINE SPANSULE dextroamphetamine sulfate | — Medicare Part D | — | — | — |
| Aminocaproic Acid aminocaproic acid | — Medicare Part D | — | — | — |
| Estarylla Norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Niacin niacin | — Medicare Part D | — | — | — |
| PNV-DHA ascorbic acid, cholecalciferol, .alpha.-tocopherol acetate, dl-, pyridoxine, folic acid, cyanocobalamin, calcium, ferrous fumarate, magnesium, doconexent | — Medicare Part D | — | — | — |
| Iodixanol Iodixanol | — Medicare Part D | — | — | — |
| Hyoscyamine Sulfate Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| Epinephrine 0.3 Adults Epinephrine 0.3 Adults | — Medicare Part D | — | — | — |
| Enhertu Enhertu | — Medicare Part D | — | — | — |
| AVYCAZ ceftazidime, avibactam | — Medicare Part D | Yes | — | — |
| Glucotrol XL glipizide | — Medicare Part D | — | — | — |
| Amitriptyline HCL Amitriptyline Hcl | — Medicare Part D | — | — | — |
| Tapentadol Hydrochloride Tapentadol Hydrochloride | — Medicare Part D | — | — | — |
| Lanthanum Carbonate Lanthanum carbonate | — Medicare Part D | — | — | — |
| SODIUM PHENYLACETATE AND SODIUM BENZOATE sodium phenylacetate and sodium benzoate | — Medicare Part D | — | — | — |
| NITROGEN Compressed, NF NITROGEN | — Medicare Part D | — | — | — |
| Belladonna and Opium ATROPA BELLADONNA and OPIUM | — Medicare Part D | — | — | — |
| BRYNOVIN Sitagliptin Hydrochloride Oral | — Medicare Part D | — | — | — |
| PHENERGAN Promethazine Hydrochloride | — Medicare Part D | — | — | — |
| Varubi rolapitant | — Medicare Part D | — | — | — |
| QTERN | — Medicare Part D | — | — | — |
| PRAVASTATIN SODIUM PRAVASTATIN SODIUM | — Medicare Part D | — | — | — |
| Esomeprazole Magnesium esomeprazole magnesium | — Medicare Part D | — | — | — |
| CILOXAN ciprofloxacin hydrochloride | — Medicare Part D | — | — | — |
| Sulconazole Nitrate Sulconazole Nitrate | — Medicare Part D | — | — | — |
| Tamsulosin Hydrochloride Tamsulosin Hydrochloride | — Medicare Part D | — | — | — |
| Indium In 111 Oxyquinoline Indium In-111 Oxyquinoline | — Medicare Part D | — | — | — |
| Atovaquone and Proguanil HCl atovaquone and proguanil hydrochloride | — Medicare Part D | — | — | — |
| BENZONATATE Benzonatate | — Medicare Part D | — | — | — |