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 |
|---|---|---|---|---|
| ClindaCare Clindamycin, Ibuprofen, Chlorhexidine Gluconate | — Medicare Part D | — | — | — |
| Nortrel 28 Day, Nortrel 21 Day | — Medicare Part D | — | — | — |
| DASH Chlorhexidine Gluconate 0.12% Oral Rinse | — Medicare Part D | — | — | — |
| Acticlate CAP doxycycline hyclate | — Medicare Part D | — | — | — |
| Eletriptan Hydrobromide Eletriptan Hydrobromide | — Medicare Part D | — | — | — |
| Fruzaqla fruquintinib | — Medicare Part D | — | — | — |
| Fareston toremifene citrate | — Medicare Part D | — | — | — |
| Ampicillin Sodium Ampicillin sodium | — Medicare Part D | — | — | — |
| SOLTAMOX TAMOXIFEN CITRATE | — Medicare Part D | — | — | — |
| Avant Benzocaine | — Medicare Part D | — | — | — |
| Latanoprost Ophthalmic Solution Latanoprost Ophthalmic Solution 0.005% | — Medicare Part D | — | — | — |
| Prolia denosumab | — Medicare Part D | Yes | — | — |
| ACETYLCYSTEINE ACETYLCYSTEINE | — Medicare Part D | — | — | — |
| Oxycodone HCl Oxycodone HCl | — Medicare Part D | — | — | — |
| Vizimpro dacomitinib | — Medicare Part D | — | — | — |
| Bendamustine Hydrochloride BENDAMUSTINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Diclofenac Sodium ER Diclofenac Sodium | — Medicare Part D | — | — | — |
| Tanlor methocarbamol | — Medicare Part D | — | — | — |
| Depo-Medrol methylprednisolone acetate | — Medicare Part D | — | — | — |
| bromfenac 0.075% bromfenac | — Medicare Part D | — | — | — |
| Capecitabine Capecitabine | — Medicare Part D | — | — | — |
| Tuberculinum TUBERCULIN PURIFIED PROTEIN DERIVATIVE | — Medicare Part D | — | — | — |
| Leucoflex CGP Anticoagulant Citrate Phosphate Dextrose Solution with Additive Solution AS-1 | — Medicare Part D | — | — | — |
| Fesoterodine Fumarate FESOTERODINE FUMARATE | — Medicare Part D | — | — | — |
| Cetrorelix Acetate cetrorelix acetate | — Medicare Part D | — | — | — |
| GEMTESA vibegron | — Medicare Part D | — | — | — |
| Palonosetron Hydrochloride Palonosetron Hydrochloride | — Medicare Part D | — | — | — |
| Lignospan Forte Lidocaine Hydrochloride and Epinephrine | — Medicare Part D | — | — | — |
| Ammonia N-13 ammonia n-13 | — Medicare Part D | — | — | — |
| EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE Emtricitabine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| gynazole 1 butoconazole nitrate | — Medicare Part D | — | — | — |
| AURLUMYN ILOPROST | — Medicare Part D | — | — | — |
| AS-3 AS-3 | — Medicare Part D | — | — | — |
| SERTRALINE Sertraline | — Medicare Part D | — | — | — |
| Isoproterenol Hydrochloride Isoproterenol Hydrochloride | — Medicare Part D | — | — | — |
| Budesonide Inhalation Suspension budesonide inhalation | — Medicare Part D | — | — | — |
| Ethambutol Hydrochloride Ethambutol Hydrochloride | — Medicare Part D | — | — | — |
| Oxycodone Hydrochloride and Acetaminophen oxycodone hydrochloride and acetaminophen | — Medicare Part D | — | — | — |
| Phenelzine Sulfate PHENELZINE SULFATE | — Medicare Part D | — | — | — |
| ZYMFENTRA infliximab-dyyb | — Medicare Part D | Yes | — | — |
| VITRASE hyaluronidase, ovine | — Medicare Part D | — | — | — |
| SPORANOX ITRACONAZOLE | — Medicare Part D | — | — | — |
| PNV-Select VITAMIN A ACETATE, ASCORBIC ACID, CHOLECALCIFEROL, ALPHA-TOCOPHEROL ACETATE, DL, THIAMINE MONONITRATE, RIBOFLAVIN, NIACINAMIDE, PYRIDOXINE HYDROCHLORIDE, FOLIC ACID, CYANOCOBALAMIN, BIOTIN, CALCIUM PANTOTHENATE, CALCIUM CARBONATE, FERROUS FUMARATE, POTASSIUM IODIDE, MAGNESIUM OXIDE, ZINC OXIDE and CUPRIC OXIDE | — Medicare Part D | — | — | — |
| Xanax alprazolam | — Medicare Part D | — | — | — |
| METHADOSE, METHADOSE SUGAR-FREE | — Medicare Part D | — | — | — |
| CPDA-1 Anticoagulant Citrate Phosphate Dextrose Adenine | — Medicare Part D | — | — | — |
| COZAAR losartan potassium | — Medicare Part D | — | — | — |
| metronidazole vaginal metronidazole | — Medicare Part D | — | — | — |
| LACTULOSE Lactulose | — Medicare Part D | — | — | — |
| IVERMECTIN ivermectin | — Medicare Part D | — | — | — |