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 |
|---|---|---|---|---|
| MYCOPHENOLIC ACID Mycophenolic Acid | — Medicare Part D | — | — | — |
| OPFOLDA miglustat | — Medicare Part D | — | — | — |
| PENICILLIN G POTASSIUM PENICILLIN G | — Medicare Part D | — | — | — |
| MIGERGOT Ergotamine Tartrate and Caffeine | — Medicare Part D | — | — | — |
| Ultra-Technekow V4 Technetium Tc-99m | — Medicare Part D | — | — | — |
| Diclofenac Sodium 1.5% Diclofenac Sodium Topical | — Medicare Part D | — | — | — |
| CROMOLYN SODIUM Cromolyn Sodium | — Medicare Part D | — | — | — |
| CERETEC TECHNETIUM TC-99M EXAMETAZIME | — Medicare Part D | — | — | — |
| Topotecan Hydrochloride Topotecan Hydrochloride | — Medicare Part D | — | — | — |
| IMATINIB MESYLATE imatinib mesylate | — Medicare Part D | — | — | — |
| Escitalopram Oxalate Escitalopram Oxalate | — Medicare Part D | — | — | — |
| PCXX NEUTRAL RNS STRAWBERRY FLUORIDE TREATMENT | — Medicare Part D | — | — | — |
| Cholestyramine Light cholestyramine light | — Medicare Part D | — | — | — |
| FENOFIBRATE Fenofibrate | — Medicare Part D | — | — | — |
| Perindopril Erbumine Perindopril Erbumine | — Medicare Part D | — | — | — |
| SERTRALINE HYDROCHLORIDE Sertraline Hydrochloride | — Medicare Part D | — | — | — |
| Pilocarpine Hydrochloride Pilocarpine Hydrochloride | — Medicare Part D | — | — | — |
| Nucynta ER tapentadol hydrochloride | — Medicare Part D | — | — | — |
| INVEGA HAFYERA paliperidone palmitate | — Medicare Part D | Yes | — | — |
| Multaq Dronedarone | — Medicare Part D | — | — | — |
| Liothyronine Sodium liothyronine sodium | — Medicare Part D | — | — | — |
| Apidra, Apidra SoloStar | — Medicare Part D | — | — | — |
| NICARDIPINE HYDROCHLORIDE Nicardipine Hydrochloride | — Medicare Part D | — | — | — |
| VIVITROL naltrexone | — Medicare Part D | Yes | — | — |
| Trikafta Elexacaftor, Tezacaftor, and Ivacaftor | — Medicare Part D | Yes | — | — |
| Mili norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Bruselix Cream Vitamin C, Zinc, Arnica Montana Extract, Bromelain, Diosmin, Rutin, Citrus Bioflavonoids, Hesperidin Methyl Chalcone | — Medicare Part D | — | — | — |
| Atovaquone and Proguanil Hydrochloride atovaquone and proguanil hydrochloride | — Medicare Part D | — | — | — |
| DOTTI Estradiol | — Medicare Part D | — | — | — |
| Prenate Mini ascorbic acid, cholecalciferol, .alpha.-tocopherol acetate, dl-, pyridoxine hydrochloride, folic acid, cyanocobalamin, biotin, calcium carbonate, ferrous asparto glycinate, iron, potassium iodide, magnesium oxide, doconexent and lowbush blueberry | — Medicare Part D | — | — | — |
| Colesevelam HCL Colesevelam HCL | — Medicare Part D | — | — | — |
| LACOSAMIDE lacosamide | — Medicare Part D | — | — | — |
| Amphetamine Extended-Release Amphetamine Extended-Release | — Medicare Part D | — | — | — |
| CARBIDOPA, LEVODOPA AND ENTACAPONE carbidopa, levodopa, and entacapone | — Medicare Part D | — | — | — |
| METOCLOPRAMIDE metoclopramide | — Medicare Part D | — | — | — |
| ERGOCALCIFEROL ergocalciferol | — Medicare Part D | — | — | — |
| Tigecycline Tigecycline | — Medicare Part D | — | — | — |
| Dimethyl Fumarate, DIMETHYL FUMARATE | — Medicare Part D | — | — | — |
| Chloroquine Phosphate CHLOROQUINE PHOSPHATE | — Medicare Part D | — | — | — |
| BRIVARACETAM brivaracetam | — Medicare Part D | — | — | — |
| Fosrenol lanthanum carbonate | — Medicare Part D | — | — | — |
| FORMOTEROL FUMARATE Formoterol Fumarate | — Medicare Part D | — | — | — |
| Levbid hyoscyamine sulfate | — Medicare Part D | — | — | — |
| Yorvipath Palopegteriparatide | — Medicare Part D | — | — | — |
| Amoxicillin Amoxicillin | — Medicare Part D | — | — | — |
| WINREVAIR SOTATERCEPT-CSRK | — Medicare Part D | Yes | — | — |
| Exelon rivastigmine | — Medicare Part D | — | — | — |
| TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN Tramadol Hydrochloride and Acetaminophen | — Medicare Part D | — | — | — |
| Diphenhydramine Dextromethorphan HBr, Guaifenesin, Diphenhydramine HCl | — Medicare Part D | — | — | — |
| DEFERASIROX Deferasirox | — Medicare Part D | — | — | — |