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 |
|---|---|---|---|---|
| Ashlyna Levonorgestrel and Ethinyl Estradiol and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| METFORMIN HYDROCHLORIDE ER Metformin hydrochloride | — Medicare Part D | — | — | — |
| Temozolomide Temozolomide | — Medicare Part D | — | — | — |
| Milrinone Lactate in 5% Dextrose Milrinone Lactate in 5% Dextrose | — Medicare Part D | — | — | — |
| JANUVIA sitagliptin | — Medicare Part D | — | — | — |
| PAVBLU aflibercept-ayyh | — Medicare Part D | — | — | — |
| Hycodan Hydrocodone Bitartrate and Homatropine Methylbromide | — Medicare Part D | — | — | — |
| Ethacrynic Acid Ethacrynic Acid | — Medicare Part D | — | — | — |
| Medical Oxygen Compressed OXYGEN | — Medicare Part D | — | — | — |
| Cortenema Hydrocortisone | — Medicare Part D | — | — | — |
| Levetiracetam Extended-Release LEVETIRACETAM | — Medicare Part D | — | — | — |
| DICLOFENAC SODIUM diclofenac sodium | — Medicare Part D | — | — | — |
| Lifitegrast Lifitegrast | — Medicare Part D | — | — | — |
| MAXALT, MAXALT-MLT | — Medicare Part D | — | — | — |
| CETIRIZINE HYDROCHLORIDE Cetirizine Hydrochloride | — Medicare Part D | — | — | — |
| Eribulin Mesylate Eribulin Mesylate | — Medicare Part D | — | — | — |
| Doxylamine Succinate and Pyridoxine Hydrochloride Doxylamine succinate and pyridoxine hydrochloride | — Medicare Part D | — | — | — |
| Ciprofloxacin Ciprofloxacin Hydrochloride | — Medicare Part D | — | — | — |
| AdreView Iobenguane I-123 | — Medicare Part D | — | — | — |
| ERYTHROMYCIN ERYTHROMYCIN | — Medicare Part D | — | — | — |
| Nystatin Cream NYSTATIN | — Medicare Part D | — | — | — |
| EPINASTINE HYDROCHLORIDE EPINASTINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Panhematin hemin | — Medicare Part D | — | — | — |
| 1% LIDOCAINE HCI 1% LIDOCAINE HCI | — Medicare Part D | — | — | — |
| Palonosetron Hydrochloride Palonosetron Hydrochloride | — Medicare Part D | — | — | — |
| Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, Amphetamine Sulfate Tablets,CII | — Medicare Part D | — | — | — |
| Dulera mometasone furoate and formoterol fumarate dihydrate | — Medicare Part D | — | — | — |
| Butalbital, Acetaminophen, and Caffeine Butalbital, Acetaminophen, and Caffeine | — Medicare Part D | — | — | — |
| Labetalol Hydrochloride Labetalol Hydrochloride | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE Bupropion hydrochloride | — Medicare Part D | — | — | — |
| Eribulin Mesylate Eribulin Mesylate | — Medicare Part D | — | — | — |
| CHLORDIAZEPOXIDE HYDROCHLORIDE CHLORDIAZEPOXIDE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Lorazepam Lorazepam | — Medicare Part D | — | — | — |
| IRBESARTAN AND HYDROCHLOROTHIAZIDE Irbesartan and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| SUNOSI solriamfetol | — Medicare Part D | — | — | — |
| Reblozyl Luspatercept | — Medicare Part D | — | — | — |
| Diclofenac Sodium Misoprostol Diclofenac Sodium and Misoprostol | — Medicare Part D | — | — | — |
| PULMICORT FLEXHALER Budesonide | — Medicare Part D | — | — | — |
| Bucapsol Buspirone Hydrochloride | — Medicare Part D | — | — | — |
| Hyoscyamine Sulfate ODT Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| Ionite APF Foam Sodium Fluoride | — Medicare Part D | — | — | — |
| Inflammacin diclofenac sodium, capsaicin | — Medicare Part D | — | — | — |
| GAMIFANT emapalumab-lzsg | — Medicare Part D | — | — | — |
| Tradjenta linagliptin | — Medicare Part D | — | — | — |
| TRIAMCINOLONE ACETONIDE Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| VFEND Voriconazole | — Medicare Part D | — | — | — |
| Neurontin gabapentin | — Medicare Part D | — | — | — |
| Pemetrexed disodium Pemetrexed Disodium | — Medicare Part D | — | — | — |
| CELECOXIB Celecoxib | — Medicare Part D | — | — | — |
| Doxorubicin Hydrochloride DOXORUBICIN HYDROCHLORIDE | — Medicare Part D | — | — | — |