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 |
|---|---|---|---|---|
| Uceris budesonide | — Medicare Part D | — | — | — |
| Bexarotene bexarotene | — Medicare Part D | — | — | — |
| VENTOLIN HFA albuterol sulfate | — Medicare Part D | — | — | — |
| NEXTERONE (AMIODARONE HCI) amiodarone hydrochloride | — Medicare Part D | — | — | — |
| QUETIAPINE FUMARATE Quetiapine Fumarate | — Medicare Part D | — | — | — |
| Potassium Acetate POTASSIUM ACETATE | — Medicare Part D | — | — | — |
| Carbon Dioxide Oxygen Mixture Carbon Dioxide Oxygen Mixture | — Medicare Part D | — | — | — |
| BRIMONIDINE TARTRATE and TIMOLOL MALEATE Brimonidine Tartrate and Timolol Maleate | — Medicare Part D | — | — | — |
| BRIXADI BUPRENORPHINE | — Medicare Part D | — | — | — |
| Hemlibra emicizumab | — Medicare Part D | — | — | — |
| Clarithromycin Clarithromycin | — Medicare Part D | — | — | — |
| Erythromycin Lactobionate Erythromycin Lactobionate | — Medicare Part D | Yes | — | — |
| L-Glutamine L-glutamine | — Medicare Part D | — | — | — |
| Rituxan Hycela rituximab and hyaluronidase | — Medicare Part D | — | — | — |
| THAM TROMETHAMINE | — Medicare Part D | — | — | — |
| Metronidazole Vaginal Gel metronidazole | — Medicare Part D | — | — | — |
| Zolpidem tartrate sublingual Zolpidem tartrate sublingual | — Medicare Part D | — | — | — |
| BARACLUDE entecavir | — Medicare Part D | — | — | — |
| AirDuo RespiClick Fluticasone Propionate and Salmeterol | — Medicare Part D | — | — | — |
| Darunavir 600 and 800 mg darunavir | — Medicare Part D | — | — | — |
| ADSOL Red Cell Preservation Solution System in Plastic Container (PL 146 Plastic) | — Medicare Part D | — | — | — |
| Methylphenidate HCl Methylphenidate HCl | — Medicare Part D | — | — | — |
| POTASSIUM IODIDE Potassium iodide | — Medicare Part D | — | — | — |
| Trifluoperazine Hydrochloride trifluoperazine hydrochloride | — Medicare Part D | — | — | — |
| Levetiracetam Levetiracetam Levetiracetam | — Medicare Part D | — | — | — |
| Oxygen, Refrigerated Oxygen, Refrigerated | — Medicare Part D | — | — | — |
| Krystexxa pegloticase | — Medicare Part D | — | — | — |
| Milrinone Lactate in Dextrose Milrinone Lactate | — Medicare Part D | — | — | — |
| BALVERSA Erdafitinib | — Medicare Part D | — | — | — |
| Layolis Fe norethindrone, ethinyl estradiol, and ferrous fumarate | — Medicare Part D | — | — | — |
| Cablivi caplacizumab | — Medicare Part D | Yes | — | — |
| asparlas calaspargase pegol | — Medicare Part D | — | — | — |
| MAGNESIUM SULFATE IN DEXTROSE Magnesium Sulfate | — Medicare Part D | — | — | — |
| DOPAMINE HCI IN 5% DEXTROSE DOPAMINE HCI IN 5% DEXTROSE | — Medicare Part D | — | — | — |
| NURTEC ODT rimegepant sulfate | — Medicare Part D | — | — | — |
| Osenvelt denosumab-bmwo | — Medicare Part D | Yes | — | — |
| Fluphenazine Decanoate Fluphenazine Decanoate | — Medicare Part D | — | — | — |
| NEXOBRID ANACAULASE-BCDB | — Medicare Part D | — | — | — |
| CHLOROPROCAINE HCI CHLOROPROCAINE HCI | — Medicare Part D | — | — | — |
| Travoprost Ophthalmic Travoprost Ophthalmic Solution | — Medicare Part D | — | — | — |
| Amphetamine Sulfate DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| Isoproterenol Hydrochloride Isoproterenol Hydrochloride | — Medicare Part D | — | — | — |
| TIGAN(R) (TRIMETHOBENZAMIDE HYDROCHLORIDE) Trimethobenzamide Hydrochloride | — Medicare Part D | — | — | — |
| Carbon Dioxide Oxygen Carbon Dioxide Oxygen | — Medicare Part D | — | — | — |
| triCitrasol Trisodium Citrate dihydrate | — Medicare Part D | — | — | — |
| BROMFENAC Bromfenac | — Medicare Part D | — | — | — |
| GOHIBIC vilobelimab | — Medicare Part D | — | — | — |
| Emerphed PFS Ephedrine Sulfate | — Medicare Part D | — | — | — |
| LOSARTAN POTASSIUM 25 mg, LOSARTAN POTASSIUM 50 mg, LOSARTAN POTASSIUM 100 mg | — Medicare Part D | — | — | — |
| Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | — Medicare Part D | — | — | — |