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 |
|---|---|---|---|---|
| PredniSONE Tablets, USP, 10 mg | — Medicare Part D | — | — | — |
| DOXY 100(TM) DOXYCYCLINE | — Medicare Part D | — | — | — |
| LISDEXAMFETAMINE DIMESYLATE Lisdexamfetamine | — Medicare Part D | — | — | — |
| Clocortolone Pivalate Clocortolone Pivalate | — Medicare Part D | — | — | — |
| Diatrizoate Meglumine and Diatrizoate Sodium diatrizoate meglumine and diatrizoate sodium | — Medicare Part D | — | — | — |
| SAMSCA tolvaptan | — Medicare Part D | — | — | — |
| Gentamicin Sulfate GENTAMICIN SULFATE | — Medicare Part D | — | — | — |
| DIGOXIN DIGOXIN | — Medicare Part D | — | — | — |
| Orilissa Elagolix | — Medicare Part D | — | — | — |
| HYDROCORTISONE ACETATE Hydrocortisone Acetate | — Medicare Part D | — | — | — |
| Crataegus HAWTHORN LEAF WITH FLOWER | — Medicare Part D | — | — | — |
| HELIUM HELIUM | — Medicare Part D | — | — | — |
| ANTICOAGULANT SODIUM CITRATE Trisodium Citrate Dihydrate | — Medicare Part D | — | — | — |
| MARLISSA Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Methylene Blue Methylene Blue | — Medicare Part D | — | — | — |
| LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE losartan potassium and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Sevoflurane, (Volatile for Inhalation) SEVOFLURANE | — Medicare Part D | — | — | — |
| Ventrixyl Folic Acid | — Medicare Part D | — | — | — |
| Carbon Dioxide Oxygen Mix Carbon Dioxide Oxygen Mix | — Medicare Part D | — | — | — |
| M-Natal Plus Vitamin A, Vitamin C, Vitamin D, Vitamin E, Thiamine, Riboflavin, Niacin, Vitamin B6, Folic Acid, Vitamin B12, Calcium, Iron, Zinc, Copper | — Medicare Part D | — | — | — |
| ARTHROTEC diclofenac sodium and misoprostol | — Medicare Part D | — | — | — |
| Sorbitol-Mannitol SORBITOL and MANNITOL | — Medicare Part D | — | — | — |
| Dyural 80 Kit Methylprednisolone Acetate, Lidocaine Hydrochloride, Bupivacaine Hydrochloride, Povidine Iodine, Sodium Chloride, Isopropyl Alcohol | — Medicare Part D | — | — | — |
| TIBSOVO ivosidenib | — Medicare Part D | — | — | — |
| CORDRAN flurandrenolide | — Medicare Part D | — | — | — |
| Gibson Healthcare Buffered Hemostatic Solution Aluminum Chloride | — Medicare Part D | — | — | — |
| Fluticasone FLUTICASONE PROPIONATE | — Medicare Part D | — | — | — |
| PONVORY Ponesimod | — Medicare Part D | — | — | — |
| Carbon Dioxide-Oxygen-Nitrogen Mixture Carbon Dioxide-Oxygen-Nitrogen Mixture | — Medicare Part D | — | — | — |
| IMUFLEX WB-SP Blood Bag System with Integral Whole Blood Leukocyte Reduction Filter (Saving Platelets) with Diversion Blood Sampling Arm Anticoagulant Citrate Phosphate Dextrose (CPD) and OPTISOL (AS-5) Red Cell Preservative for collection of 500mL of Blood | — Medicare Part D | — | — | — |
| QAMZOVA Meloxicam | — Medicare Part D | — | — | — |
| Darzalex Daratumumab | — Medicare Part D | — | — | — |
| Progesterone Progesterone | — Medicare Part D | — | — | — |
| Diclofenac diclofenac sodium | — Medicare Part D | — | — | — |
| ETHOSUXIMIDE Ethosuximide | — Medicare Part D | — | — | — |
| CYANOCOBALAMIN CYANOCOBALAMIN | — Medicare Part D | — | — | — |
| VERMOX mebendazole | — Medicare Part D | — | — | — |
| KETOCONAZOLE Ketoconazole | — Medicare Part D | — | — | — |
| Oxygen-Carbon Dioxide Mixture Oxygen-Carbon Dioxide Mixture | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 21/79 Oxygen/Nitrogen 21/79 | — Medicare Part D | — | — | — |
| GABARONE Gabapentin | — Medicare Part D | — | — | — |
| CHLORDIAZEPOXIDE HYDROCHLORIDE CHLORDIAZEPOXIDE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Midazolam In Sodium Chloride Midazolam | — Medicare Part D | — | — | — |
| SUPRANE DESFLURANE | — Medicare Part D | — | — | — |
| Plaquenil Hydroxychloroquine Sulfate | — Medicare Part D | — | — | — |
| LEQSELVI deuruxolitinib phosphate | — Medicare Part D | — | — | — |
| ABILIFY MAINTENA aripiprazole | — Medicare Part D | — | — | — |
| Arazlo tazarotene | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE Bupropion hydrochloride | — Medicare Part D | — | — | — |
| Goprelto cocaine hydrochloride | — Medicare Part D | — | — | — |