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 |
|---|---|---|---|---|
| Varenicline VARENICLINE | — Medicare Part D | — | — | — |
| PANRETIN alitretinoin | — Medicare Part D | — | — | — |
| COXANTO oxaprozin | — Medicare Part D | — | — | — |
| Methimazole Methimazole | — Medicare Part D | — | — | — |
| XURIDEN uridine triacetate | — Medicare Part D | — | — | — |
| Plasma-Lyte A Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride and Magnesium Chloride | — Medicare Part D | — | — | — |
| Glumetza metformin hydrochloride | — Medicare Part D | — | — | — |
| Amiloride Hydrochloride and Hydrochlorothiazide Amiloride Hydrochloride and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| TAZAROTENE TAZAROTENE | — Medicare Part D | — | — | — |
| Lidomax Lidomax | — Medicare Part D | — | — | — |
| Dilantin Infatabs Phenytoin | — Medicare Part D | — | — | — |
| Xiidra Lifitegrast | — Medicare Part D | — | — | — |
| Losartan Potassium losartan potassium and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Cyproheptadine Hydrochloride Cyproheptadine Hydrochloride | — Medicare Part D | — | — | — |
| ENTRESTO Sacubitril and Valsartan | — Medicare Part D | — | — | — |
| Piasky Crovalimab | — Medicare Part D | — | — | — |
| Sulfacetamide Sodium SULFACETAMIDE SODIUM | — Medicare Part D | — | — | — |
| CETIRIZINE HYDROCHLORIDE Cetirizine Hydrochloride | — Medicare Part D | — | — | — |
| Hydroxyurea HYDROXYUREA | — Medicare Part D | — | — | — |
| BIVALIRUDIN Bivalirudin | — Medicare Part D | — | — | — |
| Cetacaine Anesthetic Benzocaine, Butamben, and Tetracaine Hydrochloride | — Medicare Part D | — | — | — |
| Capecitabine Capecitabine | — Medicare Part D | — | — | — |
| KESIMPTA ofatumumab | — Medicare Part D | Yes | — | — |
| SYMBICORT Budesonide and Formoterol Fumarate Dihydrate | — Medicare Part D | — | — | — |
| Dexilant dexlansoprazole | — Medicare Part D | — | — | — |
| Cleocin T clindamycin phosphate | — Medicare Part D | — | — | — |
| Provera medroxyprogesterone acetate | — Medicare Part D | — | — | — |
| ESZOPICLONE Eszopiclone | — Medicare Part D | — | — | — |
| Barhemsys Amisulpride | — Medicare Part D | — | — | — |
| SODIUM NITROPRUSSIDE Sodium Nitroprusside | — Medicare Part D | — | — | — |
| Tolterodine Tartrate Tolterodine Tartrate | — Medicare Part D | — | — | — |
| ASPRIN AND EXTENDED-RELEASE DIPYRIDAMOLE ASPRIN AND EXTENDED-RELEASE DIPYRIDAMOLE | — Medicare Part D | — | — | — |
| PHENDIMETRAZINE TARTRATE Phendimetrazine Tartrate | — Medicare Part D | — | — | — |
| Quazepam Quazepam | — Medicare Part D | — | — | — |
| Clobezin clotrimazole and betamethasone dipropionate, zinc oxide | — Medicare Part D | — | — | — |
| Priftin rifapentine | — Medicare Part D | — | — | — |
| Blenrep belantamab mafodotin | — Medicare Part D | — | — | — |
| Vancomycin vancomycin hydrochloride | — Medicare Part D | — | — | — |
| Omeprazole, Sodium bicarbonate Omeprazole, sodium bicarbonate | — Medicare Part D | — | — | — |
| Lessina Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Primidone Primidone | — Medicare Part D | — | — | — |
| Quetiapine Quetiapine | — Medicare Part D | — | — | — |
| Herceptin Trastuzumab | — Medicare Part D | — | — | — |
| Carbidopa, Levodopa, and Entacapone carbidopa, levodopa, and entacapone | — Medicare Part D | — | — | — |
| VITAMIN D ergocalciferol | — Medicare Part D | — | — | — |
| Actos pioglitazone | — Medicare Part D | — | — | — |
| Pomalyst pomalidomide | — Medicare Part D | — | — | — |
| DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE, DEXTROAMPHETAMINE SULFATE AND AMPHETAMINE SULFATE Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate | — Medicare Part D | — | — | — |
| Duloxetine HCL DR Duloxetine HCL | — Medicare Part D | — | — | — |
| Daysee LEVONORGESTREL AND ETHINYL ESTRADIOL | — Medicare Part D | — | — | — |