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 |
|---|---|---|---|---|
| OXLUMO lumasiran | — Medicare Part D | — | — | — |
| Entyvio vedolizumab | — Medicare Part D | Yes | — | — |
| PREDNISOLONE ACETATE prednisolone acetate | — Medicare Part D | — | — | — |
| Naftin Naftifine Hydrochloride | — Medicare Part D | — | — | — |
| PALSONIFY PALTUSOTINE | — Medicare Part D | — | — | — |
| Urea 39% Cream Urea 39% Cream | — Medicare Part D | — | — | — |
| Lexapro ESCITALOPRAM | — Medicare Part D | — | — | — |
| Fluocinonide Cream FLUOCINONIDE | — Medicare Part D | — | — | — |
| Lamzede Velmanase alfa-tycv | — Medicare Part D | — | — | — |
| PEG-3350 and Electrolytes Polyethylene Glycol 3350, Sodium Sulfate Anhydrous, Sodium Bicarbonate, Sodium Chloride, Potassium Chloride | — Medicare Part D | — | — | — |
| DICLOFENAC POTASSIUM DICLOFENAC POTASSIUM | — Medicare Part D | — | — | — |
| Travoprost Travoprost | — Medicare Part D | — | — | — |
| AMLODIPINE BESYLATE Amlodipine Besylate | — Medicare Part D | — | — | — |
| MYTESI Crofelemer | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide and Sulfer Emulsion Sodium Sulfacetamide and Sulfer | — Medicare Part D | — | — | — |
| TEPADINA THIOTEPA | — Medicare Part D | — | — | — |
| CIBINQO abrocitinib | — Medicare Part D | — | — | — |
| Protopam Chloride pralidoxime chloride | — Medicare Part D | — | — | — |
| Calcitriol Calcitriol | — Medicare Part D | — | — | — |
| PARNATE tranylcypromine sulfate | — Medicare Part D | — | — | — |
| Gentamicin Sulfate GENTAMICIN SULFATE | — Medicare Part D | — | — | — |
| JAYPIRCA pirtobrutinib | — Medicare Part D | — | — | — |
| METHYLPHENIDATE HYDROCHLORIDE methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Cycloserine Cycloserine | — Medicare Part D | — | — | — |
| Macrobid Nitrofurantoin Monohydrate/Macrocrystalline | — Medicare Part D | — | — | — |
| Cotellic COBIMETINIB | — Medicare Part D | — | — | — |
| Keppra levetiracetam | — Medicare Part D | — | — | — |
| Flurbiprofen Flurbiprofen | — Medicare Part D | — | — | — |
| ZOLYMBUS bimatoprost | — Medicare Part D | — | — | — |
| Lisinopril Lisinopril | — Medicare Part D | — | — | — |
| Intrarosa Prasterone | — Medicare Part D | — | — | — |
| ANTICHOLIUM physostigmine salicylate | — Medicare Part D | — | — | — |
| Trospium Chloride Trospium Chloride | — Medicare Part D | — | — | — |
| Penicillin V Potassium Penicillin V Potassium | — Medicare Part D | — | — | — |
| Propofol Injectable Emulsion Propofol Injectable Emulsion | — Medicare Part D | — | — | — |
| AMPYRA Dalfampridine | — Medicare Part D | — | — | — |
| Lotrel amlodipine besylate and benazepril hydrochloride | — Medicare Part D | — | — | — |
| Diclofenac Sodium Gel diclofenac sodium | — Medicare Part D | — | — | — |
| Duobrii halobetasol propionate and tazarotene | — Medicare Part D | — | — | — |
| NU-DERM system NORMAL-DRY SKIN TRANSFORMATION TRIAL Hydroquinone, Homosalate, Octisalate, and Zinc Oxide | — Medicare Part D | — | — | — |
| DALFAMPRIDINE Dalfampridine | — Medicare Part D | — | — | — |
| Mesalamine Mesalamine | — Medicare Part D | — | — | — |
| ALYQ Tadalafil | — Medicare Part D | — | — | — |
| VIGABATRIN vigabatrin | — Medicare Part D | — | — | — |
| Topamax topiramate | — Medicare Part D | — | — | — |
| OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE Olmesartan Medoxomil and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Hydroxyprogesterone Caproate Hydroxyprogesterone Caproate | — Medicare Part D | — | — | — |
| PIROXICAM Piroxicam | — Medicare Part D | — | — | — |
| CEFDINIR Cefdinir | — Medicare Part D | — | — | — |
| Namzaric memantine hydrochloride and donepezil hydrochloride | — Medicare Part D | — | — | — |