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 |
|---|---|---|---|---|
| Zavesca miglustat | — Medicare Part D | — | — | — |
| Pall Sterile Cord Blood Collection Unit Sterile Cord Blood Collection Unit | — Medicare Part D | — | — | — |
| Lidovara Lidovara | — Medicare Part D | — | — | — |
| Embriva ASCORBIC ACID, CHOLECALCIFEROL, THIAMINE, PYRIDOXAL PHOSPHATE, FOLIC ACID, METHYLCOBALAMIN, CALCIUM CARBONATE, FERROUS GLUCONATE, POTASSIUM IODIDE | — Medicare Part D | — | — | — |
| esmolol hydrochloride in sodium chloride Esmolol Hydrochloride in Sodium Chloride | — Medicare Part D | — | — | — |
| Trintellix vortioxetine | — Medicare Part D | — | — | — |
| ANKTIVA nogapendekin alfa inbakicept-pmln | — Medicare Part D | — | — | — |
| TachoSil THROMBIN HUMAN and FIBRINOGEN | — Medicare Part D | — | — | — |
| LACOSAMIDE lacosamide | — Medicare Part D | — | — | — |
| Fire Benzocaine and Menthol | — Medicare Part D | — | — | — |
| Temozolomide Temozolomide | — Medicare Part D | — | — | — |
| Exenatide Exenatide | — Medicare Part D | — | — | — |
| Folitin-Z Ferrous Fumarate, Folic Acid | — Medicare Part D | — | — | — |
| Protamine Sulfate PROTAMINE SULFATE | — Medicare Part D | — | — | — |
| NEUROLITE Bicisate dihydrochloride | — Medicare Part D | — | — | — |
| Acyclovir Sodium Acyclovir Sodium | — Medicare Part D | — | — | — |
| METAVEX METAVEX | — Medicare Part D | — | — | — |
| Aciphex rabeprazole sodium | — Medicare Part D | — | — | — |
| Colibacillinum ESCHERICHIA COLI | — Medicare Part D | — | — | — |
| GOCOVRI AMANTADINE | — Medicare Part D | — | — | — |
| BL-C Kit Betamethasone Sodium Phosphate, Betamethasone Acetate, Lidocaine, Iodixanol, Povidine Iodine | — Medicare Part D | — | — | — |
| Candesartan Cilexetil and Hydrochlorothiazide Candesartan Cilexetil and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Thalomid Thalidomide | — Medicare Part D | — | — | — |
| Trulance Immediate release Plecanatide | — Medicare Part D | — | — | — |
| Vitamin B Complex thiamine hydrochloride, riboflavin 5 phosphate sodium, dexpanthenol and niacinamide | — Medicare Part D | — | — | — |
| Yaz Drospirenone and ethinyl estradiol | — Medicare Part D | — | — | — |
| Probentra Probiotic Dietary Supplement Capsules | — Medicare Part D | — | — | — |
| Duetact pioglitazone and glimepiride | — Medicare Part D | — | — | — |
| Diltiazem Hydrochloride EXTENDED RELEASE Diltiazem Hydrochloride | — Medicare Part D | — | — | — |
| Mucus Relief Guaifenesin | — Medicare Part D | — | — | — |
| ZO Skin Health Pigment Control Creme Hydroquinone Hydroquinone | — Medicare Part D | — | — | — |
| CHROMIUM Chromium Metallicum | — Medicare Part D | — | — | — |
| TICAGRELOR Ticagrelor | — Medicare Part D | — | — | — |
| CALCIUM CHLORIDE SODIUM CHLORIDE, SODIUM LACTATE, POTASSIUM CHLORIDE, and CALCIUM CHLORIDE | — Medicare Part D | — | — | — |
| DESMODA Desmopressin Acetate Oral Solution | — Medicare Part D | — | — | — |
| STERILE CORD BLOOD COLLECTION UNIT (MSC123D) Sterile Cord Blood Collection Unit | — Medicare Part D | — | — | — |
| Tirosint levothyroxine sodium | — Medicare Part D | — | — | — |
| Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound) Paclitaxel | — Medicare Part D | — | — | — |
| VENLAFAXINE HYDROCHLORIDE VENLAFAXINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Benicar olmesartan medoxomil | — Medicare Part D | — | — | — |
| NuLev hyoscyamine sulfate | — Medicare Part D | — | — | — |
| ROBAXIN methocarbamol | — Medicare Part D | — | — | — |
| Dantrolene Sodium Dantrolene Sodium | — Medicare Part D | — | — | — |
| Acarbose Acarbose | — Medicare Part D | — | — | — |
| Gomekli mirdametinib | — Medicare Part D | Yes | — | — |
| VYSCOXA Celecoxib | — Medicare Part D | — | — | — |
| OXYCODONE AND ACETAMINOPHEN oxycodone hydrochloride and acetaminophen | — Medicare Part D | — | — | — |
| Amlodipine and Atorvastatin Amlodipine and Atorvastatin | — Medicare Part D | — | — | — |
| Efavirenz EFAVIRENZ | — Medicare Part D | — | — | — |
| Daptomycin daptomycin | — Medicare Part D | — | — | — |