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 |
|---|---|---|---|---|
| NEOMYCIN POLYMYXIN B SULFATES AND DEXAMETHASONE Neomycin sulfate, Polymyxin B Sulfate and Dexamethasone | — Medicare Part D | — | — | — |
| Zemdri (plazomicin) Plazomicin | — Medicare Part D | Yes | — | — |
| Clindamycin Phosphate Clindamycin Phosphate | — Medicare Part D | — | — | — |
| Diltiazem Hydrochloride diltiazem hydrochloride | — Medicare Part D | — | — | — |
| Additive Formula 3 Dextrose Monohydrate, TRISODIUM CITRATE DIHYDRATE, Sodium Chloride, SODIUM PHOSPHATE, MONOBASIC, MONOHYDRATE, Citric Acid Monohydrate, and Adenine | — Medicare Part D | — | — | — |
| BLT-25 Kit Bupivacaine Hydrochloride, Lidocaine Hydrochloride, Triamcinolone Acetonide, Povidine Iodine | — Medicare Part D | — | — | — |
| Restasis MultiDose cyclosporine | — Medicare Part D | — | — | — |
| Atovaquone Atovaquone | — Medicare Part D | — | — | — |
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN HYDROCODONE BITARTRATE AND ACETAMINOPHEN | — Medicare Part D | — | — | — |
| Anastrozole Anastrozole | — Medicare Part D | — | — | — |
| TRIAMCINOLONE ACETONIDE Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| OBAGI-C Rx system C-CLARIFYING SERUM NORMAL TO oily SKIN LIGHTENING SERUM WITH VITAMIN C HYDROQUINONE | — Medicare Part D | — | — | — |
| ONUREG azacitidine | — Medicare Part D | — | — | — |
| VOYXACT sibeprenlimab | — Medicare Part D | Yes | — | — |
| ZYNYZ retifanlimab-dlwr | — Medicare Part D | — | — | — |
| Aripiprazole Aripiprazole | — Medicare Part D | — | — | — |
| FENOFIBRATE Fenofibrate | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE SR bupropion hydrochloride | — Medicare Part D | — | — | — |
| PANTOPRAZOLE SODIUM I.V. PANTOPRAZOLE SODIUM | — Medicare Part D | — | — | — |
| Nebivolol nebivolol | — Medicare Part D | — | — | — |
| Hydrocortisone Acetate Cream Hydrocortisone Acetate | — Medicare Part D | — | — | — |
| HYDROXYCHLOROQUINE SULFATE Hydroxychloroquine Sulfate | — Medicare Part D | — | — | — |
| Rukobia fostemsavir tromethamine | — Medicare Part D | — | — | — |
| Konvomep omeprazole and sodium bicarbonate | — Medicare Part D | — | — | — |
| Adempas riociguat | — Medicare Part D | — | — | — |
| DASATINIB dasatinib | — Medicare Part D | — | — | — |
| Sacubitril and Valsartan Sacubitril and Valsartan | — Medicare Part D | — | — | — |
| Brimonidine Tartrate brimonidine tartrate | — Medicare Part D | — | — | — |
| Tiopronin Tiopronin | — Medicare Part D | — | — | — |
| Medroxyprogesterone Acetate Injectable Suspension medroxyprogesterone acetate | — Medicare Part D | — | — | — |
| Alfuzosin Hydrochloride extended release Alfuzosin Hydrochloride | — Medicare Part D | — | — | — |
| Propranolol Hydrochloride, Propranolol hydrochloride | — Medicare Part D | — | — | — |
| Ketoprofen Ketoprofen | — Medicare Part D | — | — | — |
| OPDUALAG nivolumab and relatlimab-rmbw | — Medicare Part D | — | — | — |
| Ambrisentan Ambrisentan | — Medicare Part D | — | — | — |
| Acclean Anti-Cavity Sensitivity Relief POTASSIUM NITRATE, SODIUM FLUORIDE | — Medicare Part D | — | — | — |
| Marinol Dronabinol | — Medicare Part D | — | — | — |
| Byetta exenatide | — Medicare Part D | — | — | — |
| Epitol Carbamazepine | — Medicare Part D | — | — | — |
| OPSUMIT macitentan | — Medicare Part D | — | — | — |
| Acanya Clindamycin Phosphate and Benzoyl Peroxide | — Medicare Part D | — | — | — |
| Tamoxifen Citrate Tamoxifen Citrate | — Medicare Part D | — | — | — |
| PrednisoLONE Prednisolone | — Medicare Part D | — | — | — |
| DEMEROL MEPERIDINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| YONSA abiraterone acetate | — Medicare Part D | — | — | — |
| CARBIDOPA, LEVODOPA AND ENTACAPONE carbidopa, levodopa, and entacapone | — Medicare Part D | — | — | — |
| Fludarabine Phosphate Fludarabine phosphate | — Medicare Part D | — | — | — |
| SIRTURO Bedaquiline Fumarate | — Medicare Part D | — | — | — |
| Albuterol Sulfate Inhalation Albuterol Sulfate | — Medicare Part D | — | — | — |
| LANSOPRAZOLE LANSOPRAZOLE | — Medicare Part D | — | — | — |