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 |
|---|---|---|---|---|
| Carbon Dioxide-Air Mixture Carbon Dioxide-Air Mixture | — Medicare Part D | — | — | — |
| Naltrexone Hydrochloride Naltrexone Hydrochloride | — Medicare Part D | — | — | — |
| OHM-DREN LFT Apis Mellifica, Aranea Diadema, Berberis Vulgaris, Equisetum Hyemale, Galium Aparine, Juglans Regia, Manganum Phosphoricum, Nicotinamidum, Nitricum Acidum, Sarsaparilla, Thuja Occidentalis, Urtica Urens | — Medicare Part D | — | — | — |
| TOBRAMYCIN Tobramycin | — Medicare Part D | — | — | — |
| NUEDEXTA dextromethorphan hydrobromide and quinidine sulfate | — Medicare Part D | — | — | — |
| DERMACURE Urea 41% | — Medicare Part D | — | — | — |
| Lipitor atorvastatin calcium | — Medicare Part D | — | — | — |
| Furosemide Furosemide | — Medicare Part D | — | — | — |
| XELJANZ XR, XELJANZ | — Medicare Part D | — | — | — |
| TOUJEO, TOUJEO Max | — Medicare Part D | — | — | — |
| Siklos hydroxyurea | — Medicare Part D | — | — | — |
| LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE losartan potassium and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Hydrocortisone sodium succinate Hydrocortisone Sodium Succinate | — Medicare Part D | — | — | — |
| Effer-K 20 mEq Unflavored, Effer-K 20 mEq Orange Cream, Effer-K 10 mEq Unflavored, Effer-K 10 mEq Cherry Vanilla | — Medicare Part D | — | — | — |
| INVEGA paliperidone palmitate | — Medicare Part D | Yes | — | — |
| Rosuvastain Calcium Rosuvastain Calcium | — Medicare Part D | — | — | — |
| Sodium Fluoride 5000 PPM Sodium Fluoride | — Medicare Part D | — | — | — |
| Droxidopa Droxidopa | — Medicare Part D | — | — | — |
| Pamidronate Disodium PAMIDRONATE DISODIUM | — Medicare Part D | — | — | — |
| Macrodantin Nitrofurantoin macrocrystals | — Medicare Part D | — | — | — |
| ENALAPRIL MALEATE Enalapril Maleate | — Medicare Part D | — | — | — |
| Noxivent 102 Noxivent 102 | — Medicare Part D | — | — | — |
| Testopel testosterone | — Medicare Part D | — | — | — |
| ETOPOPHOS etoposide phosphate | — Medicare Part D | — | — | — |
| Cardiolite TETRAKIS(2-METHOXYISOBUTYLISOCYANIDE)COPPER(I) TETRAFLUOROBORATE | — Medicare Part D | — | — | — |
| Anagrelide Anagrelide | — Medicare Part D | — | — | — |
| Oravig Miconazole | — Medicare Part D | — | — | — |
| ROCURONIUM BROMIDE ROCURONIUM BROMIDE | — Medicare Part D | — | — | — |
| Azulfidine EN-tabs Sulfasalazine | — Medicare Part D | — | — | — |
| LOCAMETZ kit for the preparation of gallium Ga 68 gozetotide | — Medicare Part D | — | — | — |
| Northera droxidopa | — Medicare Part D | — | — | — |
| VALPROIC ACID Valproic Acid | — Medicare Part D | — | — | — |
| GRAFCO APPLICATOR 30 CM Silver Nitrate | — Medicare Part D | — | — | — |
| ZELSUVMI berdazimer | — Medicare Part D | — | — | — |
| Zestril Lisinopril | — Medicare Part D | — | — | — |
| DIPROLENE betamethasone dipropionate | — Medicare Part D | — | — | — |
| Tafluprost Ophthalmic tafluprost | — Medicare Part D | — | — | — |
| Cabtreo clindamycin phosphate/benzoyl peroxide/adapalene | — Medicare Part D | — | — | — |
| iDose TR Travoprost Intracameral | — Medicare Part D | — | — | — |
| DIMETHYL FUMARATE Dimethyl fumarate | — Medicare Part D | — | — | — |
| Azelaic Acid Gel Azelaic Acid | — Medicare Part D | — | — | — |
| Arava leflunomide | — Medicare Part D | — | — | — |
| Fioricet Butalbital, Acetaminophen, and Caffeine | — Medicare Part D | — | — | — |
| Zolpidem zolpidem tartrate | — Medicare Part D | — | — | — |
| Alogliptin alogliptin | — Medicare Part D | — | — | — |
| Esmolol Hydrochloride Esmolol Hydrochloride | — Medicare Part D | — | — | — |
| AMLODIPINE BESYLATE, AMLODIPINE AND BENAZEPRIL HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Coreg CR Carvedilol Phosphate | — Medicare Part D | — | — | — |
| POTASSIUM CHLORIDE IN SODIUM CHLORIDE SODIUM CHLORIDE and POTASSIUM CHLORIDE | — Medicare Part D | — | — | — |
| Epoprostenol Epoprostenol | — Medicare Part D | — | — | — |