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 |
|---|---|---|---|---|
| Montelukast Sodium Montelukast Sodium | — Medicare Part D | — | — | — |
| Levetiracetam Extended-Release LEVETIRACETAM | — Medicare Part D | — | — | — |
| OFLOXACIN ofloxacin | — Medicare Part D | — | — | — |
| Crotan Crotamiton | — Medicare Part D | — | — | — |
| Stivarga regorafenib | — Medicare Part D | — | — | — |
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN HYDROCODONE BITARTRATE AND ACETAMINOPHEN | — Medicare Part D | — | — | — |
| NebuPent PENTAMIDINE ISETHIONATE | — Medicare Part D | — | — | — |
| Phentermine and topiramate phentermine and topiramate | — Medicare Part D | — | — | — |
| ESTRADIOL VALERATE Estradiol Valerate | — Medicare Part D | — | — | — |
| POLYETHYLENE GLYCOL-3350 AND ELECTROLYTES POLYETHYLENE GLYCOL-3350 AND ELECTROLYTES | — Medicare Part D | — | — | — |
| Halog Halcinonide Cream | — Medicare Part D | — | — | — |
| DEXAMETHASONE Dexamethasone | — Medicare Part D | — | — | — |
| Imipramine Hydrochloride Imipramine Hydrochloride | — Medicare Part D | — | — | — |
| Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| HYDRALAZINE HYDROCHLORIDE Hydralazine Hydrochloride | — Medicare Part D | — | — | — |
| METRONIDAZOLE Metronidazole | — Medicare Part D | — | — | — |
| CIPROFLOXACIN HYDROCHLORIDE Ciprofloxacin Hydrochloride | — Medicare Part D | — | — | — |
| Neomycin and Polymyxin B Sulfates, Bacitracin Zinc and Hydrocortisone Neomycin sulfate and Polymyxin B Sulfate, Bacitracin Zinc and Hydrocortisone | — Medicare Part D | — | — | — |
| Norpramin desipramine hydrochloride | — Medicare Part D | — | — | — |
| KOSELUGO SELUMETINIB | — Medicare Part D | — | — | — |
| BIMATOPROST Bimatoprost | — Medicare Part D | — | — | — |
| Lovastatin lovastatin | — Medicare Part D | — | — | — |
| TAZVERIK tazemetostat | — Medicare Part D | — | — | — |
| PALIPERIDONE paliperidone | — Medicare Part D | Yes | — | — |
| Vyzulta latanoprostene bunod | — Medicare Part D | — | — | — |
| Dapsone Dapsone | — Medicare Part D | — | — | — |
| Metoprolol Succinate ER Metoprolol Succinate ER Tablets | — Medicare Part D | — | — | — |
| CINACALCET Cinacalcet | — Medicare Part D | — | — | — |
| DROXIA Hydroxyurea | — Medicare Part D | — | — | — |
| LOKELMA sodium zirconium cyclosilicate | — Medicare Part D | Yes | — | — |
| Fluoxetine HCL fluoxetine hcl | — Medicare Part D | — | — | — |
| Tolvaptan Tolvaptan | — Medicare Part D | — | — | — |
| Ringers SODIUM CHLORIDE, SODIUM LACTATE, POTASSIUM CHLORIDE, and CALCIUM CHLORIDE | — Medicare Part D | — | — | — |
| DESOXIMETASONE Desoximetasone | — Medicare Part D | — | — | — |
| Vancomycin Hydrochloride for Oral Solution vancomycin hydrochloride | — Medicare Part D | — | — | — |
| Gemcitabine Gemcitabine | — Medicare Part D | — | — | — |
| Posaconazole POSACONAZOLE | — Medicare Part D | — | — | — |
| LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE losartan potassium and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Alpha-Pro Sodium Fluoride and Hydrofluoric Acid | — Medicare Part D | Yes | — | — |
| TABRECTA capmatinib | — Medicare Part D | — | — | — |
| Buspirone Hydrochloride buspirone hydrochloride | — Medicare Part D | — | — | — |
| Lefluniclo Leflunomide and Diclofenac Sodium Gel | — Medicare Part D | — | — | — |
| Acclean Anti-Cavity SODIUM FLUORIDE | — Medicare Part D | — | — | — |
| Victoza liraglutide | — Medicare Part D | — | — | — |
| Lupron Depot-PED leuprolide acetate | — Medicare Part D | — | — | — |
| Sterile Water STERILE WATER | — Medicare Part D | — | — | — |
| ProSol Valine, Lysine, Histidine, Isoleucine, Leucine, Phenylalanine, Threonine, Methionine, Tryptophan, Alanine, Glycine, Arginine, Proline, Glutamic Acid, Serine, Aspartic Acid and Tyrosine | — Medicare Part D | Yes | — | — |
| DICYCLOMINE HYDROCHLORIDE Dicyclomine Hydrochloride | — Medicare Part D | — | — | — |
| REYATAZ ATAZANAVIR | — Medicare Part D | — | — | — |
| Hydroxyzine Hydrochloride Hydroxyzine hydrochloride | — Medicare Part D | — | — | — |