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 |
|---|---|---|---|---|
| OXYCODONE AND ACETAMINOPHEN oxycodone hydrochloride and acetaminophen | — Medicare Part D | — | — | — |
| CellCept Mycophenolate Mofetil hydrochloride | — Medicare Part D | — | — | — |
| Menatrol Folate, Multivitamin | — Medicare Part D | — | — | — |
| Cleocin clindamycin phosphate | — Medicare Part D | — | — | — |
| ROPINIROLE HYDROCHLORIDE Ropinirole Hydrochloride | — Medicare Part D | — | — | — |
| Moxifloxacin Hydrochloride Tablets, 400 mg | — Medicare Part D | — | — | — |
| Jeuveau Prabotulinum Toxin Type A | — Medicare Part D | — | — | — |
| Vecuronium Bromide VECURONIUM BROMIDE | — Medicare Part D | — | — | — |
| Tolmetin Sodium tolmetin sodium | — Medicare Part D | — | — | — |
| Levonest levonorgestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| Dialyvite 3000 Ascorbic Acid, Tocopheryl Acid Succinate, Thiamine, Riboflavin, Niacinamide, Pyridoxine, Folic Acid, Cobalamin, Biotin, Pantothenic Acid, Zinc, Selenium | — Medicare Part D | — | — | — |
| PrednisoLONE Prednisolone | — Medicare Part D | — | — | — |
| Iluvien fluocinolone acetonide | — Medicare Part D | — | — | — |
| PIOGLITAZONE Pioglitazone | — Medicare Part D | — | — | — |
| OMEPRAZOLE Omeprazole | — Medicare Part D | — | — | — |
| Venlafaxine Hydrochloride ER Venlafaxine Hydrochloride | — Medicare Part D | — | — | — |
| Ascorbic Acid Ascorbic acid | — Medicare Part D | — | — | — |
| Dantrolene Sodium Dantrolene Sodium | — Medicare Part D | — | — | — |
| GRAFAPEX treosulfan | — Medicare Part D | — | — | — |
| Terazosin Terazosin Hydrochloride | — Medicare Part D | — | — | — |
| Virexa Vitamin C, Vitamin D3, Vitamin B1, Vitamin B6, Vitamin B12, Folic Acid, NADH, Ubiquinone | — Medicare Part D | — | — | — |
| RELEUKO Filgrastim | — Medicare Part D | Yes | — | — |
| FLUCONAZOLE Fluconazole | — Medicare Part D | — | — | — |
| Sunlenca LENACAPAVIR SODIUM | — Medicare Part D | — | — | — |
| OZOBAX DS Baclofen | — Medicare Part D | — | — | — |
| Kit for the Preparation of Technetium Tc 99m Pentetate Kit for the preparation of Technetium Tc 99m Pentetate | — Medicare Part D | — | — | — |
| Xofluza BALOXAVIR MARBOXIL | — Medicare Part D | — | — | — |
| RenThyroid LEVOTHYROXINE and LIOTHYRONINE | — Medicare Part D | — | — | — |
| AMRIX Cyclobenzaprine Hydrochloride | — Medicare Part D | — | — | — |
| ETHACRYNATE SODIUM Ethacrynate Sodium | — Medicare Part D | — | — | — |
| Budesonide budesonide | — Medicare Part D | — | — | — |
| YUVAFEM Estradiol | — Medicare Part D | — | — | — |
| Alogliptin and Pioglitazone alogliptin and pioglitazone | — Medicare Part D | — | — | — |
| Tavaborole Tavaborole | — Medicare Part D | — | — | — |
| SIMLIYA Desogestrel and Ethinyl Estradiol and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Propafenone HCl Propafenone hydrochloride | — Medicare Part D | — | — | — |
| Carteolol Hydrochloride Carteolol Hydrochloride | — Medicare Part D | — | — | — |
| RESTASIS cyclosporine | — Medicare Part D | — | — | — |
| Olopatadine Hydrochloride Olopatadine Hydrochloride | — Medicare Part D | — | — | — |
| VEOPOZ Pozelimab | — Medicare Part D | — | — | — |
| Lymphastat Baptisia Tinctoria, Echinacea (Angustifolia), Lobelia Inflata, Lomatium Dissectum, Hydrastis Canadensis, Lung (Suis), Phytolacca Decandra, Symphytum Officinale, Aconitum Napellus, Arsenicum Album, Belladonna, Bryonia (Alba), Causticum, Eupatorium Perfoliatum, Ferrum Phosphoricum, Gelsemium Sempervirens, Hypericum Perforatum, Kali Carbonicum, Lachesis Mutus, Natrum Sulphuricum, Phosphorus, Pulsatilla (Pratensis), Rhus Tox, Silicea, Sulphur, Pyrogenium | — Medicare Part D | — | — | — |
| Lurasidone HCL Lurasidone HCl | — Medicare Part D | — | — | — |
| Dimenhydrinate DIMENHYDRINATE | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 10 Sulfur 2 Cleanser Sulfacetamide Sodium and Sulfur | — Medicare Part D | — | — | — |
| Tricor Fenofibrate | — Medicare Part D | — | — | — |
| VIIBRYD vilazodone hydrochloride | — Medicare Part D | — | — | — |
| PROPRANOLOL HYDROCHLORIDE propranolol hydrochloride | — Medicare Part D | — | — | — |
| Travoprost Ophthalmic Soluton Travoprost | — Medicare Part D | — | — | — |
| CARBOPROST TROMETHAMINE Carboprost Tromethamine | — Medicare Part D | — | — | — |
| Forteo Teriparatide | — Medicare Part D | — | — | — |