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 |
|---|---|---|---|---|
| Integra Plus Ferrous Fumarate and Polysacchride Iron Vitamin Mineral Complex Supplement | — Medicare Part D | — | — | — |
| 60 Second Fluoride Gel Sodium Fluoride | — Medicare Part D | — | — | — |
| KOLORZ SIXTY SECOND FLUORIDE TRIPLE MINT, KOLORZ SIXTY SECOND FLUORIDE CHERRY CHEESECAKE, KOLORZ SIXTY SECOND FLUORIDE COTTON CANDY, KOLORZ SIXTY SECOND FLUORIDE BLUE RASPBERRY, KOLORZ SIXTY SECOND FLUORIDE PINA COLADA | — Medicare Part D | — | — | — |
| Aminophylline Aminophylline | — Medicare Part D | — | — | — |
| SUMATRIPTAN SUCCINATE Sumatriptan Succinate | — Medicare Part D | — | — | — |
| Iomeron Iomeprol Injection | — Medicare Part D | — | — | — |
| ROSUVASTATIN CALCIUM Rosuvastatin Calcium | — Medicare Part D | — | — | — |
| CANDESARTAN CILEXETIL Candesartan Cilexetil | — Medicare Part D | — | — | — |
| Misoprostol MISOPROSTOL | — Medicare Part D | — | — | — |
| Candesartan Cilexetil and Hydrochlorothiazide Candesartan Cilexetil and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Timolol GFS timolol maleate | — Medicare Part D | — | — | — |
| ORFADIN Nitisinone | — Medicare Part D | — | — | — |
| Cimzia certolizumab pegol | — Medicare Part D | Yes | — | — |
| Omnaris ciclesonide | — Medicare Part D | — | — | — |
| Tlando testosterone undecanoate | — Medicare Part D | Yes | — | — |
| DONEPEZIL HYDROCHLORIDE Donepezil Hydrochloride | — Medicare Part D | — | — | — |
| Junel 21 Day, Junel Fe 28 Day | — Medicare Part D | — | — | — |
| Hemmorex-HC hydrocortisone acetate | — Medicare Part D | — | — | — |
| Irbesartan Irbesartan | — Medicare Part D | — | — | — |
| ADRENALIN(R) epinephrine | — Medicare Part D | — | — | — |
| Methimazole Methimazole | — Medicare Part D | — | — | — |
| TONMYA Cyclobenzaprine Hydrochloride | — Medicare Part D | — | — | — |
| Rozlytrek ENTRECTINIB | — Medicare Part D | — | — | — |
| Nilutamide Nilutamide | — Medicare Part D | — | — | — |
| Atenolol Atenolol | — Medicare Part D | — | — | — |
| Ambien CR zolpidem tartrate | — Medicare Part D | — | — | — |
| Apocynum cannabinum APOCYNUM CANNABINUM ROOT | — Medicare Part D | — | — | — |
| Nexiclon XR Clonidine | — Medicare Part D | — | — | — |
| Allopurinol Allopurinol | — Medicare Part D | — | — | — |
| EBANGA Ansuvimab | — Medicare Part D | — | — | — |
| LEUPROLIDE ACETATE Leuprolide Acetate | — Medicare Part D | — | — | — |
| Prolate oxycodone hydrochloride and acetaminophen | — Medicare Part D | — | — | — |
| Hydrocortisone Rectal Suspension (Retention) Hydrocortisone | — Medicare Part D | — | — | — |
| Oraverse Phentolamine Mesylate | — Medicare Part D | — | — | — |
| Balsalazide Disodium Balsalazide Disodium | — Medicare Part D | — | — | — |
| Azor amlodipine besylate and olmesartan medoxomil | — Medicare Part D | — | — | — |
| Erlotinib Hydrochloride Erlotinib Hydrochloride | — Medicare Part D | — | — | — |
| Alprostadil Alprostadil | — Medicare Part D | — | — | — |
| BUPIVACAINE HYDROCHLORIDE BUPIVACAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Isolyte S SODIUM CHLORIDE, SODIUM GLUCONATE, SODIUM ACETATE, POTASSIUM CHLORIDE, and MAGNESIUM CHLORIDE | — Medicare Part D | — | — | — |
| Indocyanine Green Indocyanine Green and Water | — Medicare Part D | — | — | — |
| Deflazacort Deflazacort | — Medicare Part D | — | — | — |
| NUEDEXTA dextromethorphan hydrobromide and quinidine sulfate | — Medicare Part D | — | — | — |
| Stiolto Respimat tiotropium bromide and olodaterol | — Medicare Part D | — | — | — |
| NETSPOT 68Ga-DOTATATE | — Medicare Part D | — | — | — |
| VISIONBLUE Trypan Blue | — Medicare Part D | — | — | — |
| Aczone dapsone | — Medicare Part D | — | — | — |
| Agaricus Muscarius AMANITA MUSCARIA FRUITING BODY | — Medicare Part D | — | — | — |
| BISOPROLOL FUMARATE Bisoprolol Fumarate | — Medicare Part D | — | — | — |
| VyLibra norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |