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 |
|---|---|---|---|---|
| ALENDRONATE SODIUM Alendronate sodium | — Medicare Part D | — | — | — |
| PCXX VANILLA ORANGE ONE MINUTE FM Sodium Fluoride | — Medicare Part D | — | — | — |
| SODIUM PHENYLACETATE AND SODIUM BENZOATE sodium phenylacetate and sodium benzoate | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 50/50 Oxygen/Nitrogen 50/50 | — Medicare Part D | — | — | — |
| NITROGLYCERIN LINGUAL Nitroglycerin | — Medicare Part D | — | — | — |
| Cystadane betaine | — Medicare Part D | — | — | — |
| Columvi Glofitamab | — Medicare Part D | — | — | — |
| CLONIDINE HYDROCHLORIDE clonidine hydrochloride | — Medicare Part D | — | — | — |
| Cyclomydril cyclopentolate hydrochloride and phenylephrine hydrochloride | — Medicare Part D | — | — | — |
| Natroba spinosad | — Medicare Part D | — | — | — |
| ESTERIFIED ESTROGENS AND METHYLTESTOSTERONE HALF STRENGTH, ESTERIFIED ESTROGENS AND METHYLTESTOSTERONE FULL STRENGTH | — Medicare Part D | — | — | — |
| Vienva TM Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| BUTALBITAL, ASPIRIN, AND CAFFEINE Butalbital, aspirin, and caffeine | — Medicare Part D | — | — | — |
| Zosyn piperacillin sodium and tazobactam sodium | — Medicare Part D | — | — | — |
| ADVAIR HFA fluticasone propionate and salmeterol xinafoate | — Medicare Part D | — | — | — |
| Clomiphene Citrate Clomiphene citrate | — Medicare Part D | — | — | — |
| CARBOPROST TROMETHAMINE Carboprost Tromethamine | — Medicare Part D | — | — | — |
| LOTEPREDNOL ETABONATE Loteprednol Etabonate | — Medicare Part D | — | — | — |
| Neomycin and Polymyxin B Sulfates neomycin sulfate, polymyxin b sulfate and hydrocortisone | — Medicare Part D | — | — | — |
| Simponi golimumab | — Medicare Part D | Yes | — | — |
| Clobetasol Propionate Cream 0.05% Clobetasol Propionate Cream 0.05% | — Medicare Part D | — | — | — |
| DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE, DEXTROAMPHETAMINE SULFATE AND AMPHETAMINE SULFATE Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate | — Medicare Part D | — | — | — |
| POKONZA Potassium Chloride | — Medicare Part D | — | — | — |
| Arformoterol Tartrate Arformoterol Tartrate | — Medicare Part D | — | — | — |
| Rivastigmine Transdermal System Rivastigmine | — Medicare Part D | — | — | — |
| Synjardy XR empagliflozin, metformin hydrochloride | — Medicare Part D | — | — | — |
| Busulfan Busulfan | — Medicare Part D | — | — | — |
| PALIPERIDONE paliperidone | — Medicare Part D | Yes | — | — |
| TALVEY talquetamab | — Medicare Part D | — | — | — |
| XYLOCAINE-MPF WITH EPI XYLOCAINE-MPF WITH EPI | — Medicare Part D | — | — | — |
| Multi-Vit-Flor SODIUM FLUORIDE, VITAMIN A ACETATE, SODIUM ASCORBATE, CHOLECALCIFEROL, .ALPHA.-TOCOPHEROL, D-, THIAMINE HYDROCHLORIDE, RIBOFLAVIN, NIACINAMIDE, PYRIDOXINE HYDROCHLORIDE, LEVOMEFOLATE CALCIUM, and CYANOCOBALAMIN | — Medicare Part D | — | — | — |
| RUBY-FILL Rubidium Rb 82 | — Medicare Part D | — | — | — |
| Reconstituted Air RECONSTITUTED AIR | — Medicare Part D | — | — | — |
| Heparin Sodium Heparin Sodium | — Medicare Part D | — | — | — |
| ATROPINE SULFATE Atropine Sulfate | — Medicare Part D | — | — | — |
| Myfembree relugolix, estradiol hemihydrate, and norethindrone acetate | — Medicare Part D | — | — | — |
| METHYLPHENIDATE HYDROCHLORIDE methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Zytiga abiraterone acetate | — Medicare Part D | — | — | — |
| Dactinomycin DACTINOMYCIN | — Medicare Part D | — | — | — |
| FENTANYL CITRATE Fentanyl Citrate | — Medicare Part D | — | — | — |
| Sulfamethoxazole and Trimethoprim Sulfamethoxazole and Trimethoprim | — Medicare Part D | — | — | — |
| Alrex loteprednol etabonate | — Medicare Part D | — | — | — |
| Fulvicin P/G 165 ULTRAMICROSIZE GRISEOFULVIN | — Medicare Part D | — | — | — |
| ALECENSA ALECTINIB HYDROCHLORIDE | — Medicare Part D | — | — | — |
| TERBUTALINE SULFATE Terbutaline Sulfate | — Medicare Part D | — | — | — |
| Signifor LAR pasireotide | — Medicare Part D | Yes | — | — |
| Biltricide praziquantel | — Medicare Part D | — | — | — |
| Calcium Chloride Dihydrate Calcium Chloride Dihydrate | — Medicare Part D | — | — | — |
| Nefazodone Hydrochloride Nefazodone Hydrochloride | — Medicare Part D | — | — | — |
| TRAMADOL HYDROCHLORIDE AND ACETAMINOPHEN Tramadol Hydrochloride and Acetaminophen | — Medicare Part D | — | — | — |