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 |
|---|---|---|---|---|
| COMETRIQ cabozantinib | — Medicare Part D | — | — | — |
| EMFLAZA deflazacort | — Medicare Part D | — | — | — |
| Plenamine LYSINE ACETATE, LEUCINE, PHENYLALANINE, VALINE, ISOLEUCINE, METHIONINE, THREONINE, TRYPTOPHAN, ALANINE, ARGININE, GLYCINE, HISTIDINE, PROLINE, GLUTAMIC ACID, SERINE, ASPARTIC ACID, and TYROSINE | — Medicare Part D | Yes | — | — |
| Neostigmine Methylsulfate neostigmine methylsulfate | — Medicare Part D | — | — | — |
| ONAPGO Apomorphine hydrochloride | — Medicare Part D | — | — | — |
| SOHONOS palovarotene | — Medicare Part D | — | — | — |
| Nulibry fosdenopterin hydrobromide | — Medicare Part D | — | — | — |
| Radiogardase Prussian blue insoluble capsules | — Medicare Part D | — | — | — |
| PRYIDOSTIGMINE BROMIDE Pyridostigmine Bromide | — Medicare Part D | — | — | — |
| TRUQAP capivasertib | — Medicare Part D | — | — | — |
| ABILIFY ARIPIPRAZOLE | — Medicare Part D | — | — | — |
| DermacinRx Therazole Pak clotrimazole and betamethasone dipropionate, zinc oxide | — Medicare Part D | — | — | — |
| Methyldopa METHYLDOPA | — Medicare Part D | — | — | — |
| ARIMIDEX Anastrozole | — Medicare Part D | — | — | — |
| Reconstituted Air RECONSTITUTED AIR | — Medicare Part D | — | — | — |
| Magnesium Sulfate MAGNESIUM SULFATE HEPTAHYDRATE | — Medicare Part D | — | — | — |
| WYMZYA Fe NORETHINDRONE AND ETHINYL ESTRADIOL | — Medicare Part D | — | — | — |
| BRINZOLAMIDE brinzolamide | — Medicare Part D | — | — | — |
| VALTYA 1/50 ethynodiol diacetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Lacrisert hydroxypropyl cellulose | — Medicare Part D | — | — | — |
| ALVAIZ Eltrombopag | — Medicare Part D | — | — | — |
| DELFLEX Dextrose Monohydrate, Sodium Chloride, Sodium Lactate, Calcium Chloride, Magnesium Chloride | — Medicare Part D | — | — | — |
| CLINDAMYCIN PALMITATE HYDROCHLORIDE (Pediatric) Clindamycin Palmitate Hydrochloride | — Medicare Part D | — | — | — |
| ANDEXXA andexanet alfa | — Medicare Part D | — | — | — |
| INLYTA axitinib | — Medicare Part D | — | — | — |
| LEUCOVORIN CALCIUM Leucovorin Calcium | — Medicare Part D | — | — | — |
| Calcium Acetate Calcium Acetate | — Medicare Part D | — | — | — |
| Tribenzor olmesartan medoxomil / amlodipine besylate / hydrochlorothiazide | — Medicare Part D | — | — | — |
| oseltamavir phosphate oseltamavir phosphate | — Medicare Part D | — | — | — |
| DAYVIGO lemborexant | — Medicare Part D | — | — | — |
| BENAZEPRIL HYDROCHLORIDE Benazepril Hydrochloride | — Medicare Part D | — | — | — |
| VENLAFAXINE venlafaxine hydrochloride | — Medicare Part D | — | — | — |
| Efavirenz, Emtricitabine And Tenofovir Disoproxil Fumarate Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| Oxygen OXYGEN | — Medicare Part D | — | — | — |
| BIVALIRUDIN Bivalirudin | — Medicare Part D | — | — | — |
| Lactated Ringers Irrigation sodium chloride, sodium lactate, potassium chloride and calcium chloride | — Medicare Part D | — | — | — |
| TRIESENCE triamcinolone acetonide | — Medicare Part D | — | — | — |
| TERBINAFINE HYDROCHLORIDE Terbinafine Hydrochloride | — Medicare Part D | — | — | — |
| VALGANCICLOVIR HYDROCHLORIDE Valganciclovir Hydrochloride | — Medicare Part D | — | — | — |
| Timolol Maleate Ophthalmic Gel Forming Solution 0.25%, Timolol Maleate Ophthalmic Gel Forming Solution 0.5% | — Medicare Part D | — | — | — |
| LAMICTAL XR lamotrigine | — Medicare Part D | — | — | — |
| KENALOG-40 TRIAMCINOLONE ACETONIDE | — Medicare Part D | — | — | — |
| Dysport Botulinum Toxin Type A | — Medicare Part D | — | — | — |
| Triloan SUIK Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| Cortifoam hydrocortisone acetate | — Medicare Part D | — | — | — |
| Dopamine Hydrochloride and Dextrose Dopamine Hydrochloride | — Medicare Part D | — | — | — |
| Halobetasol Propionate Halobetasol Propionate | — Medicare Part D | — | — | — |
| LumaSon SULFUR HEXAFLUORIDE | — Medicare Part D | — | — | — |
| OMNISCAN gadodiamide | — Medicare Part D | — | — | — |
| CHLORDIAZEPOXIDE HYDROCHLORIDE AND CLIDINIUM BROMIDE Chlordiazepoxide Hydrochloride and Clidinium Bromide | — Medicare Part D | — | — | — |