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 |
|---|---|---|---|---|
| Nymyo norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Eligard Leuprolide Acetate | — Medicare Part D | — | — | — |
| ROFLUMILAST roflumilast | — Medicare Part D | — | — | — |
| Trospium Chloride ER Trospium Chloride | — Medicare Part D | — | — | — |
| UROGESIC BLUE METHENAMINE, SODIUM PHOSPHATE, MONOBASIC, METHYLENE BLUE, and HYOSCYAMINE SULFATE | — Medicare Part D | — | — | — |
| WELLBUTRIN SR bupropion hydrochloride | — Medicare Part D | — | — | — |
| PreviDent 5000 Booster Plus Fruitastic Sodium Fluoride | — Medicare Part D | — | — | — |
| Isosorbide Dinitrate Isosorbide Dinitrate | — Medicare Part D | — | — | — |
| Telmisartan and Amlodipine telmisartan and amlodipine | — Medicare Part D | — | — | — |
| Brompheniramine Maleate, Pseudoephedrine Hydrochloride and DextromethorphanHydrobromide Brompheniramine Maleate, Pseudoephedrine Hydrochloride, and Dextromethorphan Hydrobromide | — Medicare Part D | — | — | — |
| BEYFORTUS nirsevimab | — Medicare Part D | — | — | — |
| Accucaine Lidocaine Hydrochloride | — Medicare Part D | — | Step therapy | — |
| Colesevelam Colesevelam HCL | — Medicare Part D | — | — | — |
| Tindazole Tinidazole | — Medicare Part D | — | — | — |
| Sirolimus Sirolimus | — Medicare Part D | — | — | — |
| Cefoxitin and Dextrose CEFOXITIN SODIUM | — Medicare Part D | — | — | — |
| HALOPERIDOL DECANOATE Haloperidol Decanoate | — Medicare Part D | — | — | — |
| Potassium Chloride Extended-release Potassium Chloride | — Medicare Part D | — | — | — |
| Desloratadine DESLORATADINE | — Medicare Part D | — | — | — |
| Histamine Positive Skin Test Control, histamine positive skin test control | — Medicare Part D | — | — | — |
| CASODEX Bicalutamide | — Medicare Part D | — | — | — |
| Sprix ketorolac tromethamine | — Medicare Part D | — | — | — |
| VORICONAZOLE Voriconazole | — Medicare Part D | — | — | — |
| Vascepa icosapent ethyl | — Medicare Part D | — | — | — |
| GRISEOFULVIN MICROSIZE griseofulvin | — Medicare Part D | — | — | — |
| Acthar Repository Corticotropin | — Medicare Part D | Yes | — | — |
| Krintafel tafenoquine succinate | — Medicare Part D | — | — | — |
| VIGAMOX moxifloxacin hydrochloride | — Medicare Part D | — | — | — |
| ARMLUPEG pegfilgrastim-unne | — Medicare Part D | — | — | — |
| NITROGEN NF NITROGEN | — Medicare Part D | — | — | — |
| Diltiazem HCL ER Diltiazem HCL ER | — Medicare Part D | — | — | — |
| DOBUTAMINE IN DEXTROSE DOBUTAMINE IN DEXTROSE | — Medicare Part D | — | — | — |
| Idhifa enasidenib mesylate | — Medicare Part D | — | — | — |
| InterSol Platelet Additive 3 | — Medicare Part D | — | — | — |
| Eslicarbazepine Acetate eslicarbazepine acetate | — Medicare Part D | — | — | — |
| Penicillamine Penicillamine | — Medicare Part D | — | — | — |
| VANCOMYCIN HYDROCHLORIDE Vancomycin Hydrochloride | — Medicare Part D | — | — | — |
| MYCOPHENOLATE MOFETIL Mycophenolate Mofetil | — Medicare Part D | — | — | — |
| Deferiprone deferiprone | — Medicare Part D | — | — | — |
| Omeprazole/Bicarbonate Omeprazole and Sodium Bicarbonate | — Medicare Part D | — | — | — |
| Caverject Impulse Alprostadil | — Medicare Part D | — | — | — |
| Zylet loteprednol etabonate and tobramycin | — Medicare Part D | — | — | — |
| DEXMETHYLPHENIDATE HYDROCHLORIDE Dexmethylphenidate Hydrochloride | — Medicare Part D | — | — | — |
| DYMISTA Azelastine Hydrochloride and Fluticasone Propionate | — Medicare Part D | — | — | — |
| LYUMJEV, LYUMJEV KwikPen, LYUMJEV Tempo Pen, LYUMJEV Junior KwikPen | — Medicare Part D | — | — | — |
| Ionite APF Sodium Fluoride | — Medicare Part D | — | — | — |
| Glycerol Phenylbutyrate glycerol phenylbutyrate | — Medicare Part D | — | — | — |
| Trileptal oxcarbazepine | — Medicare Part D | — | — | — |
| ZYPITAMAG Pitavastatin Magnesium | — Medicare Part D | — | — | — |
| METHSCOPOLAMINE BROMIDE methscopolamine bromide | — Medicare Part D | — | — | — |