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 |
|---|---|---|---|---|
| FOLIC ACID Folic Acid | — Medicare Part D | — | — | — |
| Penicillin G Sodium Penicillin G Sodium | — Medicare Part D | — | — | — |
| ComPare2 Black Elderberry Cold and Flu Relief Bryonia, Gelsemium sempervirens, Sambucus nigra, Sulphur, Zincum gluconicum | — Medicare Part D | — | — | — |
| AMLODIPINE BESYLATE 5 mg AMLODIPINE BESYLATE | — Medicare Part D | — | — | — |
| KLOXXADO Naloxone HCL | — Medicare Part D | — | — | — |
| PCXX MARSHMALLOW APF G Sodium Fluoride | — Medicare Part D | — | — | — |
| Fluoxetine HCL fluoxetine hcl | — Medicare Part D | — | — | — |
| BRILINTA Ticagrelor | — Medicare Part D | — | — | — |
| LOMUSTINE lomustine | — Medicare Part D | — | — | — |
| LIDOCAINE AND PRILOCAINE Lidocaine and Prilocaine | — Medicare Part D | — | — | — |
| AREXVY Respiratory Syncytial Virus Vaccine Recombinant, Adjuvanted | — Medicare Part D | — | — | — |
| Benazepril Hydrochloride and Hydrochlorothiazide Benazepril Hydrochloride and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Calcitriol Calcitriol | — Medicare Part D | — | — | — |
| Obagi Nu-Derm System Normal-Oily Skin Transformation Trial Hydroquinone, Homosalate, Octisalate, Zinc Oxide | — Medicare Part D | — | — | — |
| Escitalopram Oral Solution Escitalopram Oxalate | — Medicare Part D | — | — | — |
| SULFACETAMIDE SODIUM, SULFUR SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| Vitrexyl Folic Acid | — Medicare Part D | — | — | — |
| Ganciclovir Ganciclovir | — Medicare Part D | — | — | — |
| DIPHENHYDRAMINE HYDROCHLORIDE Diphenhydramine Hydrochloride | — Medicare Part D | — | — | — |
| Orudis Ketoprofen | — Medicare Part D | — | — | — |
| Isoflurane Isoflurane | — Medicare Part D | — | — | — |
| Albendazole Albendazole | — Medicare Part D | — | — | — |
| Clobetasol Propionate clobetasol propionate | — Medicare Part D | — | — | — |
| PRAMIPEXOLE Pramipexole Dihydrochloride | — Medicare Part D | — | — | — |
| TORPENZ Everolimus | — Medicare Part D | — | — | — |
| Hyronan Sodium Hyaluronate, Lidocaine, Isopropyl Alcohol | — Medicare Part D | — | — | — |
| Standardized Mite Dermatophagoides farinae, Standardized Mite Dermatophagoides pteronyssinus, Standardized Mite Mix Dermatophagoides farinae and Dermatophagoides pteronyssinus | — Medicare Part D | — | — | — |
| BETAPACE, BETAPACE AF | — Medicare Part D | — | — | — |
| Cyclophosphamide Cyclophosphamide | — Medicare Part D | — | — | — |
| PEMAZYRE pemigatinib | — Medicare Part D | — | — | — |
| BOTOX Cosmetic onabotulinumtoxinA | — Medicare Part D | — | — | — |
| Vitafol Ultra Doconexent, Niacinamide, .Alpha.-Tocopherol Acetate, DL-, Cholecalciferol, .Beta.-Carotene, Ascorbic Acid, Thiamine Mononitrate, Riboflavin, Pyridoxine Hydrochloride, Cyanocobalamin, Iron, Zinc Oxide, Cupric Oxide, Potassium Iodide, Magnesium Oxide, Folic Acid, and Levomefolate Calcium | — Medicare Part D | — | — | — |
| Ropivacaine Hydrochloride Ropivacaine Hydrochloride | — Medicare Part D | — | — | — |
| PROCRIT Erythropoietin | — Medicare Part D | Yes | — | — |
| Virazole Ribavirin | — Medicare Part D | — | — | — |
| Conray iothalamate meglumine | — Medicare Part D | — | — | — |
| DIPHENHYDRAMINE HYDROCHLORIDE Diphenhydramine Hydrochloride | — Medicare Part D | — | — | — |
| PredniSONE, PredniSONE Intensol | — Medicare Part D | — | — | — |
| BACTERIOSTATIC WATER Bacteriostatic Water | — Medicare Part D | — | — | — |
| Sorbitol Sorbitol | — Medicare Part D | — | — | — |
| Prenate Pixie ascorbic acid, biotin, cholecalciferol, cyanocobalamin, levomefolate calcium, folic acid, ferrous asparto glycinate, potassium iodide, pyridoxine hydrochloride, .alpha.-tocopherol acetate, dl-, Docosahexaenoic acid, and blueberry | — Medicare Part D | — | — | — |
| Trokendi XR topiramate | — Medicare Part D | — | — | — |
| DESOGESTREL AND ETHINYL ESTRADIOL AND ETHINYL ESTRADIOL desogestrel and ethinyl estradiol and ethinyl estradiol | — Medicare Part D | — | — | — |
| Amidate ETOMIDATE | — Medicare Part D | — | — | — |
| Zosyn in Galaxy Containers TAZOBACTAM SODIUM and PIPERACILLIN SODIUM | — Medicare Part D | — | — | — |
| RETHYMIC allogenic thymocyte-depleted thymus tissue-agdc | — Medicare Part D | — | — | — |
| Pediatric Infuvite Multiple Vitamins Ascorbic Acid, Vitamin A Palmitate, Cholecalciferol, Thiamine Hydrochloride, Riboflavin-5 phosphate sodium, Pyridoxine Hydrochloride, Niacinamide, Dexpanthenol, Alpha-tocopherol acetate, Vitamin K1, Folic Acid, Biotin, Cyanocobalamin | — Medicare Part D | Yes | — | — |
| Oralone Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| Melphalan Hydrochloride Melphalan hydrochloride | — Medicare Part D | — | — | — |
| Irbesartan Irbesartan | — Medicare Part D | — | — | — |