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 |
|---|---|---|---|---|
| Ibrance palbociclib | — Medicare Part D | — | — | — |
| TYZAVAN Vancomycin | — Medicare Part D | — | — | — |
| USTEKINUMAB-AAUZ ustekinumab-aauz | — Medicare Part D | — | — | — |
| Bupivacaine Hydrochloride, Bupivacaine Hydrochloride and Epinephrine | — Medicare Part D | — | — | — |
| PCXX BUBBLEGUM APF G Sodium Fluoride | — Medicare Part D | — | — | — |
| VASOPRESSIN Vasopressin | — Medicare Part D | — | — | — |
| Zileuton Zileuton | — Medicare Part D | — | — | — |
| TERBUTALINE SULFATE Terbutaline Sulfate | — Medicare Part D | — | — | — |
| Escitalopram Escitalopram Oxalate | — Medicare Part D | — | — | — |
| HARLIKU nitisinone | — Medicare Part D | — | — | — |
| CISPLATIN CISplatin | — Medicare Part D | — | — | — |
| Starjemza ustekinumab-hmny | — Medicare Part D | Yes | — | — |
| QINLOCK Ripretinib | — Medicare Part D | — | — | — |
| DESOXIMETASONE Desoximetasone | — Medicare Part D | — | — | — |
| Xeomin incobotulinumtoxinA | — Medicare Part D | — | — | — |
| Losartan Potassium losartan potassium and hydrochlorothiazide | — Medicare Part D | — | — | — |
| HALOPERIDOL DECANOATE Haloperidol Decanoate | — Medicare Part D | — | — | — |
| PENTAZOCINE HYDROCHLORIDE AND NALOXONE HYDROCHLORIDE Pentazocine Hydrochloride and Naloxone Hydrochloride | — Medicare Part D | — | — | — |
| NP THYROID 60, NP THYROID | — Medicare Part D | — | — | — |
| IBSRELA tenapanor hydrochloride | — Medicare Part D | — | — | — |
| Larin Fe 1/20 Norethindrone Acetate/Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| VIZZ Aceclidine | — Medicare Part D | — | — | — |
| INVOKANA canagliflozin | — Medicare Part D | — | — | — |
| Nystatin NYSTATIN | — Medicare Part D | — | — | — |
| KYMBEE Deflazacort | — Medicare Part D | — | — | — |
| Sofdra sofpironium bromide | — Medicare Part D | — | — | — |
| Cefpodoxime Proxetil Cefpodoxime Proxetil | — Medicare Part D | — | — | — |
| OSELTAMIVIR PHOSPHATE Oseltamivir phosphate | — Medicare Part D | — | — | — |
| TWYNEO Benzoyl Peroxide and Tretinoin | — Medicare Part D | — | — | — |
| PYRAZINAMIDE Pyrazinamide | — Medicare Part D | — | — | — |
| BISOPROLOL FUMARATE Bisoprolol Fumarate | — Medicare Part D | — | — | — |
| BUPIVACAINE HYDROCHLORIDE BUPIVACAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Kaitlib Fe norethindrone and ethinyl estradiol | — Medicare Part D | — | — | — |
| Lidoxryl Lidocaine | — Medicare Part D | — | — | — |
| DICLOXACILLIN SODIUM Dicloxacillin Sodium | — Medicare Part D | — | — | — |
| BRISDELLE paroxetine | — Medicare Part D | — | — | — |
| Rexulti BREXPIPRAZOLE | — Medicare Part D | — | — | — |
| Glyburide and Metformin Hydrochloride Glyburide and Metformin Hydrochloride | — Medicare Part D | — | — | — |
| CARDENE IV nicardipine hydrochloride | — Medicare Part D | — | — | — |
| Duloxetine D/R Duloxetine D/R | — Medicare Part D | — | — | — |
| ACETIC ACID Acetic Acid | — Medicare Part D | — | — | — |
| Esmolol Hydrochloride in Water Esmolol Hydrochloride | — Medicare Part D | — | — | — |
| KLOR-Con/EF Potassium Bicarbonate | — Medicare Part D | — | — | — |
| Lamotrigine Lamotrigine | — Medicare Part D | — | — | — |
| ABRYSVO Respiratory Syncytial Virus Vaccine | — Medicare Part D | — | — | — |
| Nitrofurantoin (monohydrate/macrocrystals) NITROFURANTOIN | — Medicare Part D | — | — | — |
| EZALLOR SPRINKLE ROSUVASTATIN | — Medicare Part D | — | — | — |
| STRENSIQ ASFOTASE ALFA | — Medicare Part D | — | — | — |
| Efudex Fluorouracil | — Medicare Part D | — | — | — |
| AMPHADASE hyaluronidase | — Medicare Part D | — | — | — |