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 |
|---|---|---|---|---|
| ACETAMINOPHEN AND CODEINE acetaminophen and codeine phosphate | — Medicare Part D | — | — | — |
| NICARDIPINE HYDROCHLORIDE Nicardipine Hydrochloride | — Medicare Part D | — | — | — |
| Cyclosporine cyclosporine | — Medicare Part D | — | — | — |
| SUSTOL granisetron | — Medicare Part D | — | — | — |
| SUMATRIPTAN Sumatriptan Succinate | — Medicare Part D | — | — | — |
| Thalitone chlorthalidone | — Medicare Part D | — | — | — |
| Cyanokit Hydroxocobalamin | — Medicare Part D | — | — | — |
| Tobramycin Inhalation tobramycin inhalation | — Medicare Part D | — | — | — |
| Xenon, Xe-133 Xenon | — Medicare Part D | — | — | — |
| Irinotecan Hydrochloride Irinotecan Hydrochloride | — Medicare Part D | — | — | — |
| Metoprolol Tartrate Metoprolol tartrate | — Medicare Part D | — | — | — |
| SUBVENITE LAMOTRIGINE | — Medicare Part D | — | — | — |
| Buprenorphine Sublingual C-III Buprenorphine Sublingual C-III | — Medicare Part D | — | — | — |
| Ziprasidone ziprasidone | — Medicare Part D | — | — | — |
| Mydriacyl tropicamide | — Medicare Part D | — | — | — |
| VITRAKVI LAROTRECTINIB | — Medicare Part D | — | — | — |
| NUPLAZID pimavanserin tartrate | — Medicare Part D | — | — | — |
| Maraviroc Maraviroc | — Medicare Part D | — | — | — |
| Vueway Gadopiclenol | — Medicare Part D | — | — | — |
| URIBEL TABS Methenamine, Benzoic Acid, Phenyl Salicylate, Methylene Blue, and Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| Nexlizet Bempedoic Acid and Ezetimibe | — Medicare Part D | — | — | — |
| ATACAND Candesartan Cilexetil | — Medicare Part D | — | — | — |
| OCUFLOX ofloxacin | — Medicare Part D | — | — | — |
| Tindamax tinidazole | — Medicare Part D | — | — | — |
| Cystagon cysteamine bitartrate | — Medicare Part D | — | — | — |
| Cetrorelix Acetate cetrorelix acetate | — Medicare Part D | — | — | — |
| PNV-Omega ascorbic acid, cholecalciferol, .alpha.-tocopherol, pyridoxine, folic acid, cyanocobalamin, calcium corbonate, ferrous fumarate, potassium iodide, magnesium, doconexent, icosapent | — Medicare Part D | — | — | — |
| Soliqua 100/33 insulin glargine and lixisenatide | — Medicare Part D | — | — | — |
| Mirena Levonorgestrel | — Medicare Part D | — | — | — |
| Estradiol Vaginal Estradiol | — Medicare Part D | — | — | — |
| Ethacrynic Acid Ethacrynic Acid | — Medicare Part D | — | — | — |
| MB CAPS methenamine, sodium phosphate, monobasic, monohydrate, phenyl salicylate, methylene blue, and hyoscyamine sulfate | — Medicare Part D | — | — | — |
| Humalog Mix75/25, Humalog Mix75/25 KwikPen | — Medicare Part D | — | — | — |
| TRIAMTERENE AND HYDROCHLOROTHIAZIDE Triamterene and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Xyzal Levocetirizine dihydrochloride | — Medicare Part D | — | — | — |
| Methsuximide Methsuximide | — Medicare Part D | — | — | — |
| Betalido Kit Betamethasone Sodium Phosphate, Betamethasone Acetate, Lidocaine, Povidine Iodine | — Medicare Part D | — | — | — |
| AQUASOL A Parenteral Water-Miscible Retinyl Palmitate | — Medicare Part D | — | — | — |
| SODIUM SULFACETAMIDE AND SULFUR Sodium Sulfacetamide and Sulfur | — Medicare Part D | — | — | — |
| PCXX WATERMELON NEUTRAL GL Sodium Fluoride | — Medicare Part D | — | — | — |
| Binosto alendronate sodium | — Medicare Part D | — | — | — |
| Ranitidine Hydrochloride Ranitidine Hydrochloride | — Medicare Part D | — | — | — |
| Difluprednate Ophthalmic difluprednate ophthalmic | — Medicare Part D | — | — | — |
| FOTIVDA Tivozanib | — Medicare Part D | — | — | — |
| EXTRANEAL icodextrin, sodium chloride, sodium lactate, calcium chloride, magnesium chloride | — Medicare Part D | — | — | — |
| Vancocin vancomycin hydrochloride | — Medicare Part D | — | — | — |
| XROMI Hydroxyurea | — Medicare Part D | — | — | — |
| Humalog KwikPen, Humalog Junior KwikPen, Humalog, Humalog Tempo Pen, Sterile Diluent | — Medicare Part D | — | — | — |
| SILVER SULFADIAZINE Silver Sulfadiazine | — Medicare Part D | — | — | — |
| Arnuity Ellipta fluticasone furoate | — Medicare Part D | — | — | — |