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 |
|---|---|---|---|---|
| MYCOPHENOLATE MOFETIL Mycophenolate Mofetil | — Medicare Part D | — | — | — |
| Procto-Med HC HYDROCORTISONE | — Medicare Part D | — | — | — |
| Alprazolam Alprazolam | — Medicare Part D | — | — | — |
| Miudella Copper | — Medicare Part D | — | — | — |
| Follistim AQ follitropin | — Medicare Part D | — | — | — |
| Chromagen ferrous asparto glycinate, ferrous fumarate, ascorbic acid, folic acid, cyanocobalamin, zinc, and intrinsic factor | — Medicare Part D | — | — | — |
| IMATINIB MESYLATE imatinib mesylate | — Medicare Part D | — | — | — |
| Dexmedetomidine HCl Dexmedetomidine HCl | — Medicare Part D | — | — | — |
| Arformoterol Tartrate Inhalation Solution Arformoterol Tartrate Inhalation | — Medicare Part D | — | — | — |
| InnoPran XL propranolol hydrochloride | — Medicare Part D | — | — | — |
| EPIPEN epinephrine | — Medicare Part D | — | — | — |
| CIDOFOVIR Cidofovir Dihydrate | — Medicare Part D | — | — | — |
| LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE losartan potassium and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Zybic Meloxicam | — Medicare Part D | — | — | — |
| Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, and AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| Metyrosine Metyrosine | — Medicare Part D | — | — | — |
| Air 90% Carbon Dioxide 10% Air 90% Carbon Dioxide 10% | — Medicare Part D | — | — | — |
| Ozempic semaglutide | — Medicare Part D | Yes | — | — |
| Kit for the Preparation of Technetium Tc99m Mertiatide Betiatide | — Medicare Part D | — | — | — |
| NADOLOL Nadolol | — Medicare Part D | — | — | — |
| PROSTIN VR PEDIATRIC alprostadil | — Medicare Part D | — | — | — |
| Gengraf Cyclosporine | — Medicare Part D | Yes | — | — |
| Atazanavir ATAZANAVIR | — Medicare Part D | — | — | — |
| MAXIDEX dexamethasone | — Medicare Part D | — | — | — |
| Amlodipine and Valsartan Amlodipine and valsartan | — Medicare Part D | — | — | — |
| VALSARTAN AND HYDROCHLOROTHIAZIDE Valsartan and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Afinitor, Afinitor Disperz | — Medicare Part D | Yes | — | — |
| Alvimopan Alvimopan | — Medicare Part D | — | — | — |
| Phenazopyridine HCL Phenazopyridine HCL | — Medicare Part D | — | — | — |
| Efavirenz EFAVIRENZ | — Medicare Part D | — | — | — |
| Visipaque Iodixanol | — Medicare Part D | — | — | — |
| Ezetimibe EZETIMIBE | — Medicare Part D | — | — | — |
| Crenessity crinecerfont | — Medicare Part D | — | — | — |
| Trazodone Hydrochloride trazodone hydrochloride | — Medicare Part D | — | — | — |
| AndroGel Testosterone | — Medicare Part D | — | — | — |
| ER 911 Aconitum nap, Apis mel, Arnica, Arsenicum alb, Belladonna, Bellis, Bryonia, Calendula, Chamomilla, Cistus canadensis, Clematis erecta, Ferrum phos, Histaminum, Hypericum, Ignatia, Impatiens glan flos, Ornithogalum, Passiflora, Phosphorus, Prunus cerasifera, Rhus tox, Sulphur, Symphytum, Vertarum alb | — Medicare Part D | — | — | — |
| Phenytoin Sodium Phenytoin Sodium | — Medicare Part D | — | — | — |
| Carbinoxamine Maleate Carbinoxamine Maleate | — Medicare Part D | — | — | — |
| Nyamyc Nystatin | — Medicare Part D | — | — | — |
| RISPERIDONE Risperidone | — Medicare Part D | — | — | — |
| Ursodiol URSODIOL | — Medicare Part D | — | — | — |
| Kit for the Preparation of Technetium Tc 99m Mebrofenin Kit for the Preparation of Technetium Tc 99m Mebrofenin | — Medicare Part D | — | — | — |
| Doxepin HCL Doxepin HCL | — Medicare Part D | — | — | — |
| Agrylin anagrelide hydrochloride | — Medicare Part D | — | — | — |
| Sodium Flouride Sodium Fluoride | — Medicare Part D | — | — | — |
| Olmesartan Medoxomil Olmesartan Medoxomil | — Medicare Part D | — | — | — |
| ENOBY Denosumab-qbde | — Medicare Part D | Yes | — | — |
| Pioglitazone and metformin hydrochloride Pioglitazone and metformin hydrochloride | — Medicare Part D | — | — | — |
| Phentermine and topiramate phentermine and topiramate | — Medicare Part D | — | — | — |
| Fluorescein Sodium and Benoxinate Hydrochloride Fluorescein Sodium and Benoxinate Hydrochloride | — Medicare Part D | — | — | — |