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 |
|---|---|---|---|---|
| Escitalopram Oxalate Escitalopram Oxalate | — Medicare Part D | — | — | — |
| Inbrija levodopa | — Medicare Part D | — | — | — |
| Gadavist gadobutrol | — Medicare Part D | — | — | — |
| AVGEMSI Gemcitabine | — Medicare Part D | — | — | — |
| Xanax XR alprazolam | — Medicare Part D | — | — | — |
| Vonjo Pacritinib | — Medicare Part D | — | — | — |
| Ustekinumab-aekn ustekinumab-aekn | — Medicare Part D | — | — | — |
| Citalopram citalopram | — Medicare Part D | — | — | — |
| Onzetra Xsail sumatriptan succinate | — Medicare Part D | — | — | — |
| Carbon Dioxide Refrigerated Carbon Dioxide | — Medicare Part D | — | — | — |
| Tavaborole Tavaborole | — Medicare Part D | — | — | — |
| Dilaudid hydromorphone hydrochloride | — Medicare Part D | — | — | — |
| BYQLOVI clobetasol propionate | — Medicare Part D | — | — | — |
| REZVOGLAR KWIKPEN Insulin glargine-aglr | — Medicare Part D | Yes | — | — |
| ADZYNMA Apadamtase Alfa | — Medicare Part D | — | — | — |
| COLESEVELAM HYDROCHLORIDE Colesevelam hydrochloride | — Medicare Part D | — | — | — |
| Nalbuphine Hydrochloride Nalbuphine Hydrochloride | — Medicare Part D | — | — | — |
| TOUJEO Max insulin glargine | — Medicare Part D | — | — | — |
| EYLEA HD aflibercept | — Medicare Part D | — | — | — |
| Posaconazole POSACONAZOLE | — Medicare Part D | — | — | — |
| LEVETIRACETAM Levetiracetam | — Medicare Part D | — | — | — |
| CIBINQO abrocitinib | — Medicare Part D | — | — | — |
| Vasopressin in 0.9% Sodium Chloride Vasopressin | — Medicare Part D | — | — | — |
| Technescan HDP Technetium Tc 99m Oxidronate | — Medicare Part D | — | — | — |
| TESTOSTERONE CYPIONATE Testosterone Cypionate | — Medicare Part D | — | — | — |
| Dronabinol Dronabinol | — Medicare Part D | — | — | — |
| LYBALVI olanzapine and samidorphan L-malate | — Medicare Part D | — | — | — |
| TRIAMTERENE AND HYDROCHLOROTHIAZIDE Triamterene and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| ARMOUR THYROID THYROID, PORCINE | — Medicare Part D | — | — | — |
| Fensolvi Leuprolide Acetate | — Medicare Part D | — | — | — |
| CLOMIPRAMINE HYDROCHLORIDE Clomipramine Hydrochloride | — Medicare Part D | — | — | — |
| Erythrocin Lactobionate ERYTHROMYCIN LACTOBIONATE | — Medicare Part D | Yes | — | — |
| Effient Prasugrel Hydrochloride | — Medicare Part D | — | — | — |
| Peridex chlorhexidine gluconate | — Medicare Part D | — | — | — |
| Geodon ziprasidone hydrochloride | — Medicare Part D | — | — | — |
| Lacosamide Oral Solution lacosamide | — Medicare Part D | — | — | — |
| Fludeoxyglucose F 18 Fludeoxyglucose F-18 | — Medicare Part D | — | — | — |
| Medroloan II SUIK Methylprednisolone Acetate | — Medicare Part D | — | — | — |
| Epidiolex cannabidiol | — Medicare Part D | — | — | — |
| ACETAMINOPHEN AND CODEINE acetaminophen and codeine phosphate | — Medicare Part D | — | — | — |
| Adalimumab adalimumab-adaz | — Medicare Part D | Yes | — | — |
| Olmesartan Medoxomil Olmesartan Medoxomil | — Medicare Part D | — | — | — |
| Icosapent Ethyl icosapent ethyl | — Medicare Part D | — | — | — |
| Ampicillin and Sulbactam ampicillin and sulbactam | — Medicare Part D | — | — | — |
| NATACYN natamycin | — Medicare Part D | Yes | — | — |
| CINVANTI aprepitant | — Medicare Part D | — | — | — |
| Sandostatin LAR Depot octreotide acetate | — Medicare Part D | — | — | — |
| PREVYMIS LETERMOVIR | — Medicare Part D | — | — | — |
| ANTICOAGULANT SODIUM CITRATE Trisodium Citrate Dihydrate | — Medicare Part D | — | — | — |
| Doxazosin Mesylate Doxazosin Mesylate | — Medicare Part D | — | — | — |