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 |
|---|---|---|---|---|
| QUINIDINE SULFATE quinidine sulfate tablet | — Medicare Part D | — | — | — |
| Lotemax SM loteprednol etabonate | — Medicare Part D | — | — | — |
| TAKHZYRO lanadelumab-flyo | — Medicare Part D | Yes | — | — |
| LEVOLEUCOVORIN CALCIUM Levoleucovorin Calcium | — Medicare Part D | — | — | — |
| BRIUMVI ublituximab | — Medicare Part D | — | — | — |
| Albuterol Sulate HFA albuterol sulfate | — Medicare Part D | — | — | — |
| TADALAFIL Tadalafil | — Medicare Part D | — | — | — |
| Xiclofen diclofenac sodium, methyl salicylate | — Medicare Part D | — | — | — |
| SEROQUEL XR quetiapine | — Medicare Part D | — | — | — |
| CYANOCOBALAMIN CYANOCOBALAMIN | — Medicare Part D | — | — | — |
| Trubrexa Patch ER | — Medicare Part D | — | — | — |
| Topotecan Hydrochloride Topotecan Hydrochloride | — Medicare Part D | — | — | — |
| VARENICLINE TARTRATE Varenicline Tartrate | — Medicare Part D | — | — | — |
| Tri-Mili Norgestimate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| IMAAVY nipocalimab | — Medicare Part D | — | — | — |
| PEG-3350, SODIUM SULFATE, SODIUM CHLORIDE, POTASSIUM CHLORIDE, SODIUM ASCORBATE AND ASCORBIC ACID PEG-3350, SODIUM SULFATE, SODIUM CHLORIDE, POTASSIUM CHLORIDE, SODIUM ASCORBATE AND ASCORBIC ACID | — Medicare Part D | — | — | — |
| PROCORT 1.85% hydrocortisone acetate - 1.15% pramoxine hci cream | — Medicare Part D | — | — | — |
| AVAR LS SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| AcetaZOLAMIDE acetazolamide | — Medicare Part D | — | — | — |
| Hydrocortisone Butyrate Hydrocortisone butyrate | — Medicare Part D | — | — | — |
| Calcipotriene calcipotriene | — Medicare Part D | — | — | — |
| Myfortic mycophenolic acid | — Medicare Part D | — | — | — |
| TRIENTINE HYDROCHLORIDE TRIENTINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Methocarbamol Methocarbamol | — Medicare Part D | — | — | — |
| Zovia 1/35 Ethynodiol Diacetate and Ethinyl Estradiol Tablets | — Medicare Part D | — | — | — |
| Rabeprazole Sodium Rabeprazole Sodium | — Medicare Part D | — | — | — |
| Sacubitril and Valsartan Sacubitril and Valsartan Sacubitril and Valsartan | — Medicare Part D | — | — | — |
| Doxycycline Hyclate doxycycline hyclate | — Medicare Part D | — | — | — |
| DOXEPIN doxepin hydrochloride | — Medicare Part D | — | — | — |
| Diovan valsartan | — Medicare Part D | — | — | — |
| ERTAPENEM SODIUM Ertapenem Sodium | — Medicare Part D | — | — | — |
| ZTALMY ganaxolone | — Medicare Part D | Yes | — | — |
| Compro PROCHLORPERAZINE | — Medicare Part D | — | — | — |
| Depen Penicillamine | — Medicare Part D | — | — | — |
| Trubrexa lidocaine and capsaicin | — Medicare Part D | — | — | — |
| ELESTRIN ESTRADIOL | — Medicare Part D | — | — | — |
| Tizanidine HCl Tizanidine HCL | — Medicare Part D | — | — | — |
| MEDROXYPROGESTERONE ACETATE Medroxyprogesterone acetate | — Medicare Part D | — | — | — |
| FINGOLIMOD fingolimod hydrochloride | — Medicare Part D | — | — | — |
| Hydrochlorothiazide Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Zumandimine Drospirenone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Ciprofloxacin HCL Ciprofloxacin HCL | — Medicare Part D | — | — | — |
| ABACAVIR and LAMIVUDINE Abacavir and Lamivudine | — Medicare Part D | — | — | — |
| Zonisamide Zonisamide | — Medicare Part D | — | — | — |
| Condylox podofilox | — Medicare Part D | — | — | — |
| Dexycu dexamethasone | — Medicare Part D | — | — | — |
| Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate | — Medicare Part D | — | — | — |
| Levalbuterol Inhalation Solution levalbuterol inhalation 1.25mg/3mL | — Medicare Part D | — | — | — |
| HUMALOG Insulin lispro | — Medicare Part D | — | — | — |
| Contrave Extended-Release naltrexone hydrochloride and bupropion hydrochloride | — Medicare Part D | — | — | — |