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 |
|---|---|---|---|---|
| SAVAYSA EDOXABAN TOSYLATE | — Medicare Part D | — | — | — |
| YUTIQ FLUOCINOLONE ACETONIDE | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 9% - Sulfur 4.5% Wash SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| BIVALIRUDIN Bivalirudin | — Medicare Part D | — | — | — |
| Carbocaine Mepivacaine Hydrochloride | — Medicare Part D | — | — | — |
| MEDROXYPROGESTERONE ACETATE Medroxyprogesterone acetate | — Medicare Part D | — | — | — |
| Infuvite Pediatric multiple vitamins injection | — Medicare Part D | — | — | — |
| XARELTO rivaroxaban | — Medicare Part D | — | — | — |
| Brompheniramine Maleate, Pseudoephedrine Hydrochloride, Dextromethorphan Hydrobromide Brompheniramine Maleate, Pseudoephedrine Hydrochloride, and Dextromethorphan Hydrobromide | — Medicare Part D | — | — | — |
| ALYACEN 1/35 norethindrone and ethinyl estradiol | — Medicare Part D | — | — | — |
| LIDO BDK Lidocaine, Prilocaine | — Medicare Part D | — | — | — |
| MITIGO Morphine Sulfate | — Medicare Part D | — | — | — |
| Cefazolin Sodium CEFAZOLIN SODIUM | — Medicare Part D | — | — | — |
| Nitrogen, Refrigerated Nitrogen, Refrigerated | — Medicare Part D | — | — | — |
| Nystatin NYSTATIN | — Medicare Part D | — | — | — |
| Bendeka bendamustine hydrochloride | — Medicare Part D | — | — | — |
| Hydrochlorothiazide Hydrochlorothiazide | — Medicare Part D | — | — | — |
| TELMISARTAN AND HYDROCHLOROTHIAZIDE Telmisartan and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Formoterol Fumarate Inhalation Solution formoterol fumarate dihydrate | — Medicare Part D | — | — | — |
| Kit for the Preparation of Indium In 111 Pentetreotide Indium In-111 Pentetreotide | — Medicare Part D | — | — | — |
| SEROQUEL quetiapine | — Medicare Part D | — | — | — |
| sulfacetamide sodium and sulfur Sodium Sulfacetamide - Sulfur sulfacetamide sodium and sulfur | — Medicare Part D | — | — | — |
| Tyvaso DPI treprostinil | — Medicare Part D | — | — | — |
| Caduet amlodipine and atorvastatin | — Medicare Part D | — | — | — |
| Nimodipine nimodipine | — Medicare Part D | — | — | — |
| EPSOLAY Benzoyl Peroxide | — Medicare Part D | — | — | — |
| Articaine Hydrochloride and Epinephrine Articaine Hydrochloride and Epinephrine | — Medicare Part D | — | — | — |
| HYLENEX Recombinant Hyaluronidase | — Medicare Part D | — | — | — |
| HYDROMORPHONE HYDROCHLORIDE HYDROMORPHONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| FYARRO Sirolimus | — Medicare Part D | — | — | — |
| Humira Adalimumab | — Medicare Part D | Yes | — | — |
| Uracin 20% Urea 20% | — Medicare Part D | — | — | — |
| C20H10Na2O5 Fluorescein Sodium Ophthalmic Strips Fluorescein Sodium | — Medicare Part D | — | — | — |
| AZASITE azithromycin monohydrate | — Medicare Part D | — | — | — |
| Clindamycin in 5 Percent Dextrose Clindamycin in 5 Percent Dextrose | — Medicare Part D | — | — | — |
| Clopidogrel Clopidogrel | — Medicare Part D | — | — | — |
| Emtricitabine/TDF Emtricitabine/TDF | — Medicare Part D | — | — | — |
| Carbidopa-levodopa carbidopa and levodopa | — Medicare Part D | — | — | — |
| Pyridostigmine Bromide PYRIDOSTIGMINE BROMIDE | — Medicare Part D | — | — | — |
| Jemperli dostarlimab | — Medicare Part D | — | — | — |
| Oxytocin OXYTOCIN | — Medicare Part D | — | — | — |
| TESTOSTERONE Testosterone | — Medicare Part D | — | — | — |
| Mycophenolate Mofetil, mycophenolate mofetil | — Medicare Part D | — | — | — |
| Pregnyl CHORIOGONADOTROPIN ALFA | — Medicare Part D | — | — | — |
| Ertaczo Sertaconazole Nitrate | — Medicare Part D | — | — | — |
| Dexmedetomidine, Dexmedetomidine in Dextrose | — Medicare Part D | — | — | — |
| Dutasteride and Tamsulosin Hydrochloride Dutasteride and Tamsulosin Hydrochloride | — Medicare Part D | — | — | — |
| Oxygen/Helium 40/60 Oxygen/Helium 40/60 | — Medicare Part D | — | — | — |
| PRO Gel 5000 Mint, PRO Gel 5000 Citrus | — Medicare Part D | — | — | — |
| OXYTROL Oxybutynin | — Medicare Part D | — | — | — |