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 |
|---|---|---|---|---|
| SEREVENT DISKUS salmeterol xinafoate | — Medicare Part D | — | — | — |
| Zolmitriptan Zolmitriptan | — Medicare Part D | — | — | — |
| Cupric Chloride CUPRIC CHLORIDE | — Medicare Part D | — | — | — |
| Metformin HCL Metformin HCl | — Medicare Part D | — | — | — |
| VALGANCICLOVIR HYDROCHLORIDE Valganciclovir Hydrochloride | — Medicare Part D | — | — | — |
| Daraprim pyrimethamine | — Medicare Part D | — | — | — |
| Valacyclovir Valacyclovir | — Medicare Part D | — | — | — |
| AVSOLA infliximab-axxq | — Medicare Part D | — | — | — |
| Griseofulvin Griseofulvin | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 52/48 Oxygen/Nitrogen 52/48 | — Medicare Part D | — | — | — |
| Docetaxel Docetaxel | — Medicare Part D | — | — | — |
| ZALEPLON Zaleplon | — Medicare Part D | — | — | — |
| BP Vit 3 folic acid, pyridoxine hydrochloride, cyanocobalamin, omega-3 fatty acids, doconexent, icosapent and .beta.-sitosterol | — Medicare Part D | — | — | — |
| Trijardy XR empagliflozin, linagliptin, metformin hydrochloride | — Medicare Part D | — | — | — |
| Potassium Chloride for Oral Solution Potassium Chloride for Oral Solution | — Medicare Part D | — | — | — |
| Clindamycin Phosphate Clindamycin Phosphate | — Medicare Part D | — | — | — |
| Vitafol Fe Plus DOCONEXENT, NIACINAMIDE, .ALPHA.-TOCOPHEROL ACETATE, DL-, CHOLECALCIFEROL, BETA CAROTENE, ASCORBIC ACID, THIAMINE MONONITRATE, Riboflavin, Pyridoxine Hydrochloride, CYANOCOBALAMIN, Iron, ZINC OXIDE, CUPRIC OXIDE, POTASSIUM IODIDE, MAGNESIUM OXIDE, Folic Acid, and LEVOMEFOLATE CALCIUM | — Medicare Part D | — | — | — |
| NULOJIX BELATACEPT | — Medicare Part D | — | — | — |
| DELSTRIGO doravirine, lamivudine, and tenofovir disoproxil fumarate | — Medicare Part D | — | — | — |
| Paclitaxel protein-bound particles Paclitaxel | — Medicare Part D | — | — | — |
| Econazole Nitrate Econazole nitrate | — Medicare Part D | — | — | — |
| Zyprexa, ZYPREXA Intramuscular, ZYPREXA Zydis | — Medicare Part D | Yes | — | — |
| UROCIT-K potassium citrate | — Medicare Part D | — | — | — |
| 25% Dextrose Infant 25% Dextrose Infant | — Medicare Part D | — | — | — |
| Desflurane DESFLURANE | — Medicare Part D | — | — | — |
| Jasmiel Drospirenone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Hyoscyamine ER hyoscyamine sulfate | — Medicare Part D | — | — | — |
| Temazepam temazepam | — Medicare Part D | — | — | — |
| Metolazone Metolazone | — Medicare Part D | — | — | — |
| glydo lidocaine hydrochloride | — Medicare Part D | — | — | — |
| OXYCODONE AND ACETAMINOPHEN oxycodone hydrochloride and acetaminophen | — Medicare Part D | — | — | — |
| Incassia NORETHINDRONE | — Medicare Part D | — | — | — |
| Dextrose in Lactated Ringers DEXTROSE, SODIUM CHLORIDE, SODIUM LACTATE, POTASSIUM CHLORIDE, and CALCIUM CHLORIDE | — Medicare Part D | — | — | — |
| ELAPRASE idursulfase | — Medicare Part D | — | — | — |
| Compressed Oxygen Compressed Oxygen | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 10 Sulfur 5 Cleanser Sulfacetamide Sodium and Sulfur | — Medicare Part D | — | — | — |
| Magnesium Sulfate MAGNESIUM SULFATE HEPTAHYDRATE | — Medicare Part D | — | — | — |
| ondansetron hydrochloride, ondansetron | — Medicare Part D | — | — | — |
| Thioridazine Hydrochloride thioridazine hydrochloride | — Medicare Part D | — | — | — |
| Remodulin, Sterile Diluent for Remodulin | — Medicare Part D | — | — | — |
| Mirabegron Mirabegron | — Medicare Part D | — | — | — |
| Potassium Citrate and Citric Acid Potassium Citrate and Citric Acid | — Medicare Part D | — | — | — |
| Potassium Chloride Extended-release Potassium Chloride | — Medicare Part D | — | — | — |
| EvexiTHROID LEVOTHYROXINE and LIOTHYRONINE | — Medicare Part D | — | — | — |
| PROSCAR FINASTERIDE | — Medicare Part D | — | — | — |
| Losartan potassium Tablets, 100 mg LOSARTAN POTASSIUM | — Medicare Part D | — | — | — |
| Low-Ogestrel Norgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Claravis Isotretinoin | — Medicare Part D | — | — | — |
| POLYMYXIN B Polymyxin B sulfate | — Medicare Part D | — | — | — |
| Memantine memantine hydrochloride and donepezil hydrochloride | — Medicare Part D | — | — | — |