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 |
|---|---|---|---|---|
| Elrexfio elranatamab-bcmm | — Medicare Part D | — | — | — |
| Affodel Norethindrone | — Medicare Part D | — | — | — |
| Fluorescein fluorescein | — Medicare Part D | — | — | — |
| Obagi Nu-Derm System Normal-Dry Skin Transformation Hydroquinone, Titanium Dioxide, and Zinc Oxide | — Medicare Part D | — | — | — |
| Colistimethate Colistimethate Sodium | — Medicare Part D | — | — | — |
| PROCAINAMIDE HCI PROCAINAMIDE HCI | — Medicare Part D | — | — | — |
| Tasmar Tolcapone | — Medicare Part D | — | — | — |
| Cefuroxime Axetil Cefuroxime Axetil | — Medicare Part D | — | — | — |
| INSULIN GLARGINE insulin glargine | — Medicare Part D | — | — | — |
| Baqsimi glucagon | — Medicare Part D | Yes | — | — |
| Diclona Lidocaine 4.5%, Diclofenac 1% | — Medicare Part D | — | — | — |
| BabyBIG human botulinum neurotoxin a/b immune globulin | — Medicare Part D | — | — | — |
| BELRAPZO bendamustine hydrochloride | — Medicare Part D | — | — | — |
| LOPRESSOR metoprolol tartrate | — Medicare Part D | — | — | — |
| Ultane Sevoflurane | — Medicare Part D | — | — | — |
| Oxycodone Hydrochloride and Acetaminophen oxycodone hydrochloride and acetaminophen | — Medicare Part D | — | — | — |
| DEBLITANE Norethindrone | — Medicare Part D | — | — | — |
| TRANEXAMIC ACID TRANEXAMIC ACID | — Medicare Part D | — | — | — |
| Lamotrigine Lamotrigine | — Medicare Part D | — | — | — |
| Portrazza necitumumab | — Medicare Part D | — | — | — |
| Prempro, Premphase | — Medicare Part D | — | — | — |
| Calcipotriene calcipotriene | — Medicare Part D | — | — | — |
| Vinorelbine Vinorelbine | — Medicare Part D | — | — | — |
| Allopurinol Allopurinol | — Medicare Part D | — | — | — |
| TPOXX tecovirimat monohydrate | — Medicare Part D | — | — | — |
| DRAXIMAGE MAA Kit for the preparation of Technetium Tc 99m Albumin aggregated | — Medicare Part D | — | — | — |
| DOXIL doxorubicin hydrochloride | — Medicare Part D | — | — | — |
| Lorazepam Lorazepam | — Medicare Part D | — | — | — |
| Granisetron Hydrochloride Granisetron Hydrochloride | — Medicare Part D | — | — | — |
| MANNITOL mannitol | — Medicare Part D | — | — | — |
| Focalin XR dexmethylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Tetrabenazine Tetrabenazine | — Medicare Part D | — | — | — |
| BUPRENORPHINE HYDROCHLORIDE and NALOXONE HYDROCHLORIDE DIHYDRATE BUPRENORPHINE HYDROCHLORIDE and NALOXONE HYDROCHLORIDE DIHYDRATE | — Medicare Part D | — | — | — |
| LANSOPRAZOLE LANSOPRAZOLE | — Medicare Part D | — | — | — |
| Fluticasone FLUTICASONE PROPIONATE | — Medicare Part D | — | — | — |
| FML fluorometholone | — Medicare Part D | — | — | — |
| RYDAPT RYDAPT | — Medicare Part D | — | — | — |
| SUPPRELIN LA histrelin acetate | — Medicare Part D | — | — | — |
| POTASSIUM CHLORIDE IN SODIUM CHLORIDE SODIUM CHLORIDE and POTASSIUM CHLORIDE | — Medicare Part D | — | — | — |
| Aromasin exemestane | — Medicare Part D | — | — | — |
| Diazepam Intensol Diazepam Intensol | — Medicare Part D | — | — | — |
| Haloperidol haloperidol | — Medicare Part D | — | — | — |
| Nortrel 7/7/7 (28 Day Regimen) Norethindrone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| IMVEXXY estradiol | — Medicare Part D | — | — | — |
| Diclofenac Sodium/Misoprostol DICLOFENAC-SODIUM-MISOPROSTOL Diclofenac Sodium/Misoprostol | — Medicare Part D | — | — | — |
| Benznidazole benznidazole | — Medicare Part D | — | — | — |
| Dextroamphetamine DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| Isosulfan Blue ISOSULFAN BLUE | — Medicare Part D | — | — | — |
| Mupirocin Mupirocin | — Medicare Part D | — | — | — |
| Doxycycline Hyclate, Doxycycline | — Medicare Part D | — | — | — |