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 |
|---|---|---|---|---|
| AMLODIPINE AND OLMESARTAN MEDOXOMIL Amlodipine and Olmesartan Medoxomil | — Medicare Part D | — | — | — |
| NovoLog Mix 70/30 insulin aspart | — Medicare Part D | — | — | — |
| Liquid Polibar Plus Barium Sulfate | — Medicare Part D | — | — | — |
| IDkit HP ONE citric acid anhydrous and 13C urea | — Medicare Part D | — | — | — |
| Eptifibatide Eptifibatide | — Medicare Part D | — | — | — |
| Amoxicillin/Clav Pot Oral Susp | — Medicare Part D | — | — | — |
| Aurovela 24 Fe Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| Xcopri, Xcopri Maintenance Pack, Xcopri Titration Pack | — Medicare Part D | — | — | — |
| KYPROLIS carfilzomib | — Medicare Part D | — | — | — |
| Sulindac sulindac | — Medicare Part D | — | — | — |
| Fluconazole in Sodium Chloride Fluconazole in Sodium Chloride | — Medicare Part D | — | — | — |
| Alosetron Alosetron Hydrochloride | — Medicare Part D | — | — | — |
| LEVONORGESTREL AND ETHINYL ESTRADIOL AND ETHINYL ESTRADIOL levonorgestrel and ethinyl estradiol and ethinyl estradiol | — Medicare Part D | — | — | — |
| Insulin Lispro Insulin lispro | — Medicare Part D | — | — | — |
| Levobunolol Hydrochloride Levobunolol Hydrochloride | — Medicare Part D | — | — | — |
| TESTOSTERONE Testosterone | — Medicare Part D | — | — | — |
| Swabs Isopropyl Alcohol | — Medicare Part D | — | — | — |
| Pentamidine Isethionate PENTAMIDINE ISETHIONATE | — Medicare Part D | — | — | — |
| oxybutynin oxybutynin | — Medicare Part D | — | — | — |
| Bleomycin BLEOMYCIN | — Medicare Part D | — | — | — |
| Gatifloxacin Ophthalmic Solution 0.5% | — Medicare Part D | — | — | — |
| Short Ragweed Ambrosia artemisiifolia | — Medicare Part D | — | — | — |
| Insulin Glargine Solostar, Insulin Glargine | — Medicare Part D | Yes | — | — |
| Spinraza Nusinersen | — Medicare Part D | — | — | — |
| BUTALBITAL, ASPIRIN, CAFFEINE AND CODEINE PHOSPHATE Butalbital, Aspirin, Caffeine and Codeine Phosphate | — Medicare Part D | — | — | — |
| amlodipine,valsartan and hydrochlorothiazide Amlodipine, Valsartan and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| AZELASTINE HYDROCHLORIDE AND FLUTICASONE PROPIONATE Azelastine hydrochloride and Fluticasone propionate | — Medicare Part D | — | — | — |
| Humalog Mix50/50 KwikPen Insulin lispro | — Medicare Part D | — | — | — |
| Cilostazol Cilostazol | — Medicare Part D | — | — | — |
| Topiramate Topiramate | — Medicare Part D | — | — | — |
| KYBELLA Deoxycholic Acid | — Medicare Part D | — | — | — |
| LINCOMYCIN Lincomycin Hydrochloride | — Medicare Part D | — | — | — |
| Fluticasone Propionate HFA fluticasone propionate | — Medicare Part D | — | — | — |
| CINQAIR Reslizumab | — Medicare Part D | — | — | — |
| URELLE hyoscyamine sulfate, methenamine, methylene blue, phenyl salicylate, and sodium phosphate, monobasic, monohydrate | — Medicare Part D | — | — | — |
| Emzahh NORETHINDRONE | — Medicare Part D | — | — | — |
| GABAPENTIN gabapentin | — Medicare Part D | — | — | — |
| LEVOPHED(R) NOREPINEPHRINE BITARTRATE | — Medicare Part D | — | — | — |
| COMBIGAN brimonidine tartrate, timolol maleate | — Medicare Part D | — | — | — |
| ABACAVIR and LAMIVUDINE Abacavir and Lamivudine | — Medicare Part D | — | — | — |
| CYSTARAN cysteamine hydrochloride | — Medicare Part D | — | — | — |
| Dyanavel XR, DYANAVEL XR | — Medicare Part D | — | — | — |
| Lo Simpesse Levonorgestrel and Ethinyl Estradiol and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Neo/Poly-B/Dex Ophth Oint Neo/Poly-B/Dex Ophth Oint | — Medicare Part D | — | — | — |
| Potassium Chloride ER Potassium Chloride ER | — Medicare Part D | — | — | — |
| XTAMPZA ER OXYCODONE | — Medicare Part D | — | — | — |
| Buprenorphine Hydrochloride BUPRENORPHINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| TORSEMIDE Torsemide | — Medicare Part D | — | — | — |
| Intralipid I.V. Fat Emulsion | — Medicare Part D | Yes | — | — |
| ILUMYA tildrakizumab-asmn | — Medicare Part D | Yes | — | — |