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 |
|---|---|---|---|---|
| Methazolamide Methazolamide | — Medicare Part D | — | — | — |
| Aripiprazole Aripiprazole | — Medicare Part D | — | — | — |
| OJEMDA TOVORAFENIB | — Medicare Part D | Yes | — | — |
| Sildenafil Sildenafil | — Medicare Part D | — | — | — |
| Xerava eravacycline | — Medicare Part D | — | — | — |
| Cefuroxime sodium Cefuroxime Sodium | — Medicare Part D | — | — | — |
| Pegasys peginterferon alfa-2a | — Medicare Part D | Yes | — | — |
| NYSTATIN AND TRIAMCINOLONE ACETONIDE nystatin and triamcinolone acetonide | — Medicare Part D | — | — | — |
| CYSTEINE HYDROCHLORIDE Cysteine Hydrochloride | — Medicare Part D | — | — | — |
| DARZALEX, Darzalex IV | — Medicare Part D | — | — | — |
| Hydrocortisone Acetate Pramoxine Hcl Hydrocortisone Acetate Pramoxine Hcl | — Medicare Part D | — | — | — |
| BUPRENORPHINE Buprenorphine | — Medicare Part D | — | — | — |
| CREXONT carbidopa and levodopa | — Medicare Part D | — | — | — |
| Amphetamine Sulfate DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| INVEGA SUSTENNA paliperidone palmitate | — Medicare Part D | Yes | — | — |
| FANAPT ILOPERIDONE | — Medicare Part D | — | — | — |
| Protonix Delayed-Release PANTOPRAZOLE SODIUM | — Medicare Part D | — | — | — |
| Digitalis purpurea Cactus Grandiflorus, L-Carnitine, Linum Usitatissimum, Strophanthus Hispidus, Borago Officinalis, Heart (Suis), Kali Carbonicum, Kali Nitricum, Thyroidinum (Suis), Adonis Vernalis, Digitalis Purpurea, Lycopus Virginicus | — Medicare Part D | — | — | — |
| Febuxostat febuxostat | — Medicare Part D | — | — | — |
| ARZERRA ofatumumab | — Medicare Part D | — | — | — |
| Nicotrol nicotine | — Medicare Part D | — | — | — |
| Amitriptyline Hydrochloride Amitriptyline Hydrochloride | — Medicare Part D | — | — | — |
| CEFDINIR Cefdinir | — Medicare Part D | — | — | — |
| MANNITOL mannitol | — Medicare Part D | — | — | — |
| ZIRGAN ganciclovir | — Medicare Part D | — | — | — |
| Alendronate Alendronate sodium | — Medicare Part D | — | — | — |
| Tolterodine Tartrate Tolterodine Tartrate | — Medicare Part D | — | — | — |
| Potassium Chloride POTASSIUM CHLORIDE | — Medicare Part D | — | — | — |
| AKLIEF trifarotene | — Medicare Part D | — | — | — |
| Colestid Colestipol Hydrochloride | — Medicare Part D | — | — | — |
| OHM-OST Arnica Montana, Calcarea Phosphorica, Causticum, China Officinalis, Colchicum Autumnale, Dulcamara, Ledum Palustre, Rhus Toxicodendron, Symphytum Officinale | — Medicare Part D | — | — | — |
| Synjardy empagliflozin and metformin hydrochloride | — Medicare Part D | — | — | — |
| Fluorodopa F18 Fluorodopa F18 | — Medicare Part D | — | — | — |
| Fluvoxamine Maleate Fluvoxamine Maleate | — Medicare Part D | — | — | — |
| Robinul | — Medicare Part D | — | — | — |
| Isturisa osilodrostat | — Medicare Part D | — | — | — |
| Edetate Calcium Disodium Edetate Calcium Disodium | — Medicare Part D | — | — | — |
| RIFAMPIN Rifampin | — Medicare Part D | — | — | — |
| Ayuna Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| NALOXONE HCI NALOXONE HCI | — Medicare Part D | — | — | — |
| LANREOTIDE ACETATE lanreotide acetate | — Medicare Part D | — | — | — |
| Amlodipine and Atorvastatin Amlodipine and Atorvastatin | — Medicare Part D | — | — | — |
| Sacubitril and Valsartan Sacubitril and Valsartan | — Medicare Part D | — | — | — |
| Ampicillin Sodium and Sulbactam Sodium Ampicillin Sodium and Sulbactam Sodium | — Medicare Part D | — | — | — |
| ENTERO Vu 24% barium sulfate | — Medicare Part D | — | — | — |
| Ganciclovir Ganciclovir | — Medicare Part D | — | — | — |
| TechneLite Technetium Tc99m Generator | — Medicare Part D | — | — | — |
| Nortriptyline Hydrochloride Nortriptyline Hydrochloride | — Medicare Part D | — | — | — |
| Atorvastatin Calcium Atorvastatin Calcium | — Medicare Part D | — | — | — |
| ADCIRCA Tadalafil | — Medicare Part D | — | — | — |