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 |
|---|---|---|---|---|
| Efavirenz, Lamivudine and Tenofovir Disoproxil Fumarate Efavirenz, Lamivudine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| DAPZURA RT daptomycin | — Medicare Part D | — | — | — |
| TAUVID Flortaucipir F-18 | — Medicare Part D | — | — | — |
| Telmisartan telmisartan | — Medicare Part D | — | — | — |
| Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| Prednisone delayed release Prednisone | — Medicare Part D | — | — | — |
| Mavyret Glecaprevir and Pibrentasvir | — Medicare Part D | — | — | — |
| Torisel temsirolimus | — Medicare Part D | — | — | — |
| 50% DEXTROSE 50% DEXTROSE | — Medicare Part D | — | — | — |
| Varophen Diclofenac Sodium and Menthol, Methyl salicylate | — Medicare Part D | — | — | — |
| Desvenlafaxine ER Desvenlafaxine ER | — Medicare Part D | — | — | — |
| Rabeprazole Sodium Rabeprazole Sodium | — Medicare Part D | — | — | — |
| CAMILA NORETHINDRONE | — Medicare Part D | — | — | — |
| Glofil-125 Sodium Iothalamate I-125 injection | — Medicare Part D | — | — | — |
| Proteus ACTIVATED CHARCOAL - AETHUSA CYNAPIUM - ALTHAEA OFFICINALIS LEAF - BILBERRY - CANDIDA ALBICANS - UNCARIA TOMENTOSA - ESCHERICHIA COLI - INDOLE - MERCURIUS SOLUBILIS - OKOUBAKA AUBREVILLEI BARK - PORK LIVER - PROTEUS VULGARIS - SILYBUM MARIANUM SEED - SKATOLE - STRYCHNOS NUX-VOMICA SEED - SUS SCROFA COLON - SUS SCROFA GALL BLADDER - SUS SCROFA PANCREAS - TABEBUIA IMPETIGINOSA BARK - TARAXACUM OFFICINALE - VERATRUM ALBUM ROOT - | — Medicare Part D | — | — | — |
| epiduo forte adapalene and benzoyl peroxide | — Medicare Part D | — | — | — |
| SEZABY phenobarbital sodium | — Medicare Part D | — | — | — |
| APONVIE APREPITANT | — Medicare Part D | — | — | — |
| DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE | — Medicare Part D | — | — | — |
| Jencycla norethindrone | — Medicare Part D | — | — | — |
| ZOMACTON somatropin | — Medicare Part D | Yes | — | — |
| Buprenorphine HCl and Naloxone HCl Buprenorphine and Naloxone | — Medicare Part D | — | — | — |
| QUINAPRIL Quinapril Hydrochloride | — Medicare Part D | — | — | — |
| SEMGLEE insulin glargine-yfgn | — Medicare Part D | — | — | — |
| Darunavir Darunavir | — Medicare Part D | — | — | — |
| Nitrofurantoin (monohydrate/macrocrystals) NITROFURANTOIN | — Medicare Part D | — | — | — |
| RETACRIT epoetin alfa-epbx | — Medicare Part D | Yes | — | — |
| Sodium Fluoride Gel Sodium fluoride | — Medicare Part D | — | — | — |
| Folixia Multivitamin | — Medicare Part D | — | — | — |
| PIVYA Pivmecillinam | — Medicare Part D | — | — | — |
| Pentazocine and naloxone Pentazocine hydrochloride and naloxone hydrochloride | — Medicare Part D | — | — | — |
| NORMOSOL-M AND DEXTROSE dextrose monohydrate, sodium chloride, potassium acetate, and magnesium acetate | — Medicare Part D | — | — | — |
| MERILOG insulin aspart-szjj | — Medicare Part D | Yes | — | — |
| PROLEUKIN aldesleukin | — Medicare Part D | — | — | — |
| 1% LIDOCAINE HCI, 2% LIDOCAINE HCI | — Medicare Part D | — | — | — |
| Desmopressin Acetate Desmopressin Acetate | — Medicare Part D | — | — | — |
| BIVIGAM Immune Globulin Intravenous (Human) 10% | — Medicare Part D | Yes | — | — |
| BYLVAY odevixibat | — Medicare Part D | — | — | — |
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN HYDROCODONE BITARTRATE AND ACETAMINOPHEN | — Medicare Part D | — | — | — |
| Midazolam Hydrochloride MIDAZOLAM HYDROCHLORIDE | — Medicare Part D | — | — | — |
| OHM Mouthwash Arnica Montana, Borax, Calendula Officinalis, Hypericum Perforatum, Myrrha, Plantago Major, Ratanhia, Salvia Officinalis, Symphytum Officinale. | — Medicare Part D | — | — | — |
| LIDOCAINE Lidocaine HCl, Menthol | — Medicare Part D | — | — | — |
| Caspofungin Acetate Caspofungin Acetate | — Medicare Part D | — | — | — |
| ALYACEN 1/35, ALYACEN 7/7/7 | — Medicare Part D | — | — | — |
| Loratadine Loratadine | — Medicare Part D | — | — | — |
| Calcitonin Salmon Calcitonin Salmon | — Medicare Part D | — | — | — |
| Ceftazidime Ceftazidime | — Medicare Part D | — | — | — |
| Aridol Bronchial Challenge Test Kit mannitol | — Medicare Part D | — | — | — |
| MLK F3 Kit marcaine, lidocaine, kenalog, povidone iodine | — Medicare Part D | — | — | — |
| Voraxaze glucarpidase | — Medicare Part D | — | — | — |