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 |
|---|---|---|---|---|
| Ketorocaine LM Kit Ketorolac Tromethamine, Lidocaine Hydrochloride, Bupivacaine Hydrochloride, Povidine Iodine | — Medicare Part D | — | — | — |
| LUPKYNIS Voclosporin | — Medicare Part D | — | — | — |
| JAKAFI ruxolitinib | — Medicare Part D | — | — | — |
| Mefloquine Hydrochloride Mefloquine Hydrochloride | — Medicare Part D | — | — | — |
| Nivestym filgrastim-aafi | — Medicare Part D | Yes | — | — |
| TALTZ ixekizumab | — Medicare Part D | Yes | — | — |
| Bruselix Bruising Vitamin C, Zinc, Arnica Montana Extract, Bromelain, Diosmin, Rutin, Citrus Bioflavonoids, Hesperidin Methyl Chalcone | — Medicare Part D | — | — | — |
| Adenosine ADENOSINE | — Medicare Part D | — | — | — |
| FLUCONAZOLE Fluconazole | — Medicare Part D | — | — | — |
| VYJUVEK VYJUVEK | — Medicare Part D | — | — | — |
| SULFATRIM Sulfamethoxazole and Trimethoprim | — Medicare Part D | — | — | — |
| Avonex, Avonex Pen, AVONEX | — Medicare Part D | Yes | — | — |
| Ceftriaxone Ceftriaxone Sodium | — Medicare Part D | — | — | — |
| GUNA-DIUR amiloride - apis mellifera - berberis vulgaris fruit - hieracium pilosella flowering top - hydrochlorothiazide - solidago virgaurea flowering top - spironolactone - sus scrofa pituitary gland - | — Medicare Part D | — | — | — |
| ABIGALE LO, ABIGALE | — Medicare Part D | — | — | — |
| Levorphanol Tartrate Levorphanol Tartrate | — Medicare Part D | — | — | — |
| Mupirocin Mupirocin | — Medicare Part D | — | — | — |
| COLESEVELAM HYDROCHLORIDE Colesevelam hydrochloride | — Medicare Part D | — | — | — |
| Losartan potassium Tablets, 50 mg LOSARTAN POTASSIUM | — Medicare Part D | — | — | — |
| Oxymorphone Hydrochloride Oxymorphone hydrochloride | — Medicare Part D | — | — | — |
| Trazodone Hydrochloride trazodone hydrochloride | — Medicare Part D | — | — | — |
| Gentak Gentamicin Sulfate | — Medicare Part D | — | — | — |
| THIAMINE HYDROCHLORIDE Thiamine Hydrochloride | — Medicare Part D | — | — | — |
| Symtuza Darunavir, Cobicistat, Emtricitabine, and Tenofovir alafenamide | — Medicare Part D | — | — | — |
| OXALIPLATIN Oxaliplatin | — Medicare Part D | — | — | — |
| Budesonide budesonide | — Medicare Part D | — | — | — |
| Cosentyx secukinumab | — Medicare Part D | Yes | — | — |
| Nateglinide Nateglinide | — Medicare Part D | — | — | — |
| EKTERLY sebetralstat | — Medicare Part D | — | — | — |
| Choline C 11 Choline C-11 | — Medicare Part D | — | — | — |
| ORKAMBI lumacaftor and ivacaftor | — Medicare Part D | — | — | — |
| Ketamine Hydrochloride ketamine hydrochloride | — Medicare Part D | — | — | — |
| Sodium Citrate w/v Anticoagulant TRISODIUM CITRATE DIHYDRATE | — Medicare Part D | — | — | — |
| Irinotecan Hydrochloride Irinotecan Hydrochloride | — Medicare Part D | — | — | — |
| LAMICTAL, LAMICTAL ODT | — Medicare Part D | — | — | — |
| Siyntherma Plus Lidocaine | — Medicare Part D | — | — | — |
| QUINAPRIL HYDROCHLORIDE/HYDROCHLOROTHIAZIDE QUINAPRIL HYDROCHLORIDE/HYDROCHLOROTHIAZIDE | — Medicare Part D | — | — | — |
| VERELAN PM verapamil hydrochloride | — Medicare Part D | — | — | — |
| ELTROMBOPAG eltrombopag | — Medicare Part D | — | — | — |
| ENCELTO revakinagene taroretcel-lwey | — Medicare Part D | — | — | — |
| Ephedrine Sulfate Ephedrine Sulfate | — Medicare Part D | — | — | — |
| Ciprofloxacin Otic Solution, 0.2% | — Medicare Part D | — | — | — |
| Cardizem CD diltiazem hydrochloride | — Medicare Part D | — | — | — |
| Aplenzin bupropion hydrobromide | — Medicare Part D | — | — | — |
| Ceanothus americanus Amanita muscaria Fruiting Body, Arsenic trioxide, Milk Thistle, Ceanothus americanus Leaf, Cinchona officinalis Bark, Glechoma hederacea Flowering Top, Grindelia hirsutula whole, and Sodium chloride | — Medicare Part D | — | — | — |
| Volnea Desogestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| AVMAPKI FAKZYNJA CO-PACK avutometinib potassium and defactinib hydrochloride | — Medicare Part D | — | — | — |
| XDEMVY Lotilaner ophthalmic solution | — Medicare Part D | — | — | — |
| ADAKVEO crizanlizumab | — Medicare Part D | — | — | — |
| Regadenoson Regadenoson | — Medicare Part D | — | — | — |