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 |
|---|---|---|---|---|
| VYVGART EFGARTIGIMOD ALFA | — Medicare Part D | Yes | — | — |
| Repaglinide Repaglinide | — Medicare Part D | — | — | — |
| DESIPRAMINE HYDROCHLORIDE Desipramine Hydrochloride | — Medicare Part D | — | — | — |
| CYRAMZA ramucirumab | — Medicare Part D | — | — | — |
| LYUMJEV Insulin lispro-aabc | — Medicare Part D | Yes | — | — |
| Herceptin Hylecta Trastuzumab and hyaluronidase-oysk | — Medicare Part D | — | — | — |
| SPRYCEL dasatinib | — Medicare Part D | — | — | — |
| Olanzapine Intramuscular Olanzapine | — Medicare Part D | — | — | — |
| CIMETIDINE Cimetidine | — Medicare Part D | — | — | — |
| Tivicay dolutegravir sodium | — Medicare Part D | Yes | — | — |
| CEVIMELINE HYDROCHLORIDE cevimeline hydrochloride | — Medicare Part D | — | — | — |
| Ifosfamide ifosfamide | — Medicare Part D | — | — | — |
| Simlandi adalimumab-ryvk | — Medicare Part D | — | — | — |
| ULTRAVATE Halobetasol propionate | — Medicare Part D | — | — | — |
| Mifepristone Mifepristone | — Medicare Part D | — | — | — |
| Tretinoin (Microsphere) Tretinoin | — Medicare Part D | — | — | — |
| IBUPROFEN ibuprofen | — Medicare Part D | — | — | — |
| Tafluprost Tafluprost | — Medicare Part D | — | — | — |
| FINGOLIMOD fingolimod hydrochloride | — Medicare Part D | — | — | — |
| EPYSQLI Eculizumab-aagh | — Medicare Part D | — | — | — |
| Noritate metronidazole | — Medicare Part D | — | — | — |
| NORETHINDRONE ACETATE AND ETHINYL ESTRADIOL norethindrone acetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Spironolactone and Hydrochlorothiazide spironolactone and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Sucralfate oral suspension Sucralfate | — Medicare Part D | — | — | — |
| Zolpidem Tartrate zolpidem tartrate | — Medicare Part D | — | — | — |
| Baricitinib BARICITINIB | — Medicare Part D | — | — | — |
| Promethazine Hydrochloride and Codeine Phosphate Promethazine Hydrochloride and Codeine Phosphate | — Medicare Part D | — | — | — |
| Isosorbide Mononitrate Isosorbide Mononitrate | — Medicare Part D | — | — | — |
| Lantus Solostar, Lantus | — Medicare Part D | — | — | — |
| ZALTRAP ziv-aflibercept | — Medicare Part D | — | — | — |
| Levocarnitine Levocarnitine | — Medicare Part D | — | — | — |
| CAMCEVI LEUPROLIDE | — Medicare Part D | — | — | — |
| ZUSDURI Mitomycin | — Medicare Part D | — | — | — |
| Juxtapid lomitapide mesylate | — Medicare Part D | — | — | — |
| Septocaine and Epinephrine Articaine Hydrochloride and Epinephrine Bitartrate | — Medicare Part D | — | — | — |
| SUMATRIPTAN SUCCINATE Sumatriptan Succinate | — Medicare Part D | — | — | — |
| ZOOBY Turtle Melon Sodium Fluoride | — Medicare Part D | — | — | — |
| Lynparza olaparib | — Medicare Part D | — | — | — |
| MIDAZOLAM IN 0.8% SODIUM CHLORIDE MIDAZOLAM IN 0.8% SODIUM CHLORIDE | — Medicare Part D | — | — | — |
| Viberzi Eluxadoline | — Medicare Part D | — | — | — |
| CLOTRIMAZOLE AND BETAMETHASONE DIPROPIONATE Clotrimazole and Betamethasone Dipropionate | — 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 | — | — | — |
| Ondansetron ODT Ondansetron | — Medicare Part D | — | — | — |
| AIMOVIG erenumab-aooe | — Medicare Part D | Yes | — | — |
| DABIGATRAN ETEXILATE dabigatran etexilate | — Medicare Part D | — | — | — |
| Ofloxacin Ophth Soln Ofloxacin Ophth Soln | — Medicare Part D | — | — | — |
| Bendamustine Hydrochloride BENDAMUSTINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| ZEVASKYN prademagene zamikeracel | — Medicare Part D | — | — | — |
| Foscarnet Sodium foscarnet sodium | — Medicare Part D | — | — | — |
| Pramosone hydrocortisone acetate and pramoxine hydrochloride | — Medicare Part D | — | — | — |