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 |
|---|---|---|---|---|
| Crinone progesterone | — Medicare Part D | — | — | — |
| Moxifloxacin Ophthalmic Solution Moxifloxacin ophthalmic | — Medicare Part D | — | — | — |
| XARELTO rivaroxaban | — Medicare Part D | — | — | — |
| LEUPROLIDE ACETATE Leuprolide Acetate | — Medicare Part D | — | — | — |
| MOXIFLOXACIN HYDROCHLORIDE MOXIFLOXACIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| CLOFARABINE Clofarabine | — Medicare Part D | — | — | — |
| Elemar Patch Lidocaine | — Medicare Part D | — | — | — |
| Latanoprost Latanoprost | — Medicare Part D | — | — | — |
| Naproxen Sodium Naproxen Sodium | — Medicare Part D | — | — | — |
| DICLOFENAC POTASSIUM DICLOFENAC POTASSIUM | — Medicare Part D | — | — | — |
| Clindamycin Phosphate Clindamycin Phosphate | — Medicare Part D | — | — | — |
| ConZip tramadol hydrochloride | — Medicare Part D | — | — | — |
| COLESEVELAM HYDROCHLORIDE Colesevelam hydrochloride | — Medicare Part D | — | — | — |
| LACTATED RINGERS SODIUM CHLORIDE, SODIUM LACTATE, POTASSIUM CHLORIDE, and CALCIUM CHLORIDE | — Medicare Part D | — | — | — |
| Mestinon pyridostigmine bromide | — Medicare Part D | — | — | — |
| Fesoterodine Fumarate FESOTERODINE FUMARATE | — Medicare Part D | — | — | — |
| Albuterol Sulfate HFA Albuterol Sulfate | — Medicare Part D | — | — | — |
| SIMBRINZA brinzolamide/brimonidine tartrate | — Medicare Part D | — | — | — |
| Ciclopirox Olamine Ciclopirox Olamine | — Medicare Part D | — | — | — |
| Ayvakit avapritinib | — Medicare Part D | — | — | — |
| Daunorubicin Hydrochloride Daunorubicin Hydrochloride | — Medicare Part D | — | — | — |
| Diethylpropion Hydrochloride ER Diethylpropion Hydrochloride | — Medicare Part D | — | — | — |
| Lotemax loteprednol etabonate | — Medicare Part D | — | — | — |
| E-Z-Paque barium sulfate | — Medicare Part D | — | — | — |
| SODIUM POLYSTYRENE SULFONATE sodium polystyrene sulfonate | — Medicare Part D | — | — | — |
| Carisoprodol Tablets, USP, 350 mg | — Medicare Part D | — | — | — |
| JORNAY PM Extended-Release Methylphenidate Hydrochloride | — Medicare Part D | — | — | — |
| LOTRONEX alosetron hydrochloride | — Medicare Part D | — | — | — |
| SEGLUROMET ertugliflozin and metformin hydrochloride | — Medicare Part D | — | — | — |
| VOQUEZNA DUAL PAK, VOQUEZNA TRIPLE PAK | — Medicare Part D | — | — | — |
| TYSABRI natalizumab | — Medicare Part D | — | — | — |
| DermacinRx Surgical ComboPak Chlorhexidine Gluconate Surgical Combo Kit | — Medicare Part D | — | — | — |
| Carafate Sucralfate | — Medicare Part D | — | — | — |
| Ciprofloxacin HCl Ophthalmic Ciprofloxacin Hydrochloride | — Medicare Part D | — | — | — |
| BASAGLAR KwikPen, BASAGLAR Tempo Pen | — Medicare Part D | — | — | — |
| Methocarbamol Methocarbamol | — Medicare Part D | — | — | — |
| Augtyro repotrectinib | — Medicare Part D | — | — | — |
| CARBIDOPA AND LEVODOPA Carbidopa and Levodopa | — Medicare Part D | — | — | — |
| Zolpidem Tartrate zolpidem tartrate | — Medicare Part D | — | — | — |
| YARTEMLEA narsoplimab | — Medicare Part D | — | — | — |
| VENOFER (IRON SUCROSE) iron sucrose | — Medicare Part D | — | — | — |
| BIMATOPROST Bimatoprost | — Medicare Part D | — | — | — |
| CEVIMELINE cevimeline hydrochloride | — Medicare Part D | — | — | — |
| KHAPZORY levoleucovorin | — Medicare Part D | — | — | — |
| Mitomycin Mitomycin | — Medicare Part D | — | — | — |
| AMLODIPINE BESYLATE 10 mg AMLODIPINE BESYLATE | — Medicare Part D | — | — | — |
| ALTUVIIIO Antihemophilic Factor (Recombinant), Fc-VWF-XTEN Fusion Protein-ehtl | — Medicare Part D | — | — | — |
| Montelukast Sodium Montelukast Sodium | — Medicare Part D | — | — | — |
| Hydro-Q Hydroquinone | — Medicare Part D | — | — | — |
| 40% Oxygen/Nitrogen Mix 40% Oxygen/Nitrogen Mix | — Medicare Part D | — | — | — |