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 |
|---|---|---|---|---|
| OXYCODONE HYDROCHLORIDE, OXYCODONE AND ACETAMINOPHEN | — Medicare Part D | — | — | — |
| Anastrozole Anastrozole | — Medicare Part D | — | — | — |
| Febuxostat febuxostat | — Medicare Part D | — | — | — |
| Fosinopril Sodium Fosinopril Sodium | — Medicare Part D | — | — | — |
| TYVASO treprostinil | — Medicare Part D | — | — | — |
| Phentermine HCL Phentermine Hcl | — Medicare Part D | — | — | — |
| Pemfexy pemetrexed | — Medicare Part D | — | — | — |
| Oxybutynin Chloride Extended Release Oxybutynin Chloride | — Medicare Part D | — | — | — |
| Melphalan Hydrochloride Melphalan hydrochloride | — Medicare Part D | — | — | — |
| LIDOCAINE HYDROCHLORIDE, HYDROCORTISONE ACETATE LIDOCAINE HYDROCHLORIDE, HYDROCORTISONE ACETATE | — Medicare Part D | — | — | — |
| TIAZAC EXTENDED RELEASE diltiazem hydrochloride | — Medicare Part D | — | — | — |
| DermacinRx PHN Pak lidocaine | — Medicare Part D | — | — | — |
| Brevibloc esmolol hydrochloride | — Medicare Part D | — | — | — |
| DULOXETINE HYDROCHLORIDE DULOXETINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Harvoni LEDIPASVIR and SOFOSBUVIR | — Medicare Part D | — | — | — |
| CLOBAZAM Clobazam | — Medicare Part D | — | — | — |
| FEIRZA 1/20 Norethindrone Acetate and Ethinyl Estradiol Tablets USP, 1 mg/0.02 mg and Ferrous Fumarate Tablets, 75 mg | — Medicare Part D | — | — | — |
| Oxygen Compressed U.S.P, Oxygen Refrigerated Liquid U.S.P | — Medicare Part D | — | — | — |
| Bortezomib BORTEZOMIB | — Medicare Part D | — | — | — |
| Hydrocodone APAP Hydrocodone APAP | — Medicare Part D | — | — | — |
| ZEMBRACE SYMTOUCH Sumatriptan Succinate | — Medicare Part D | — | — | — |
| Lithium Carbonate lithium carbonate | — Medicare Part D | — | — | — |
| LACTULOSE Crystalline lactulose | — Medicare Part D | — | — | — |
| Lidotral 5% Gel Lidocaine HCl | — Medicare Part D | — | — | — |
| DASATINIB dasatinib | — Medicare Part D | — | — | — |
| Azelaic Acid Azelaic Acid | — Medicare Part D | — | — | — |
| Eribulin Mesylate Eribulin Mesylate | — Medicare Part D | — | — | — |
| Doxercalciferol DOXERCALCIFEROL | — Medicare Part D | — | — | — |
| Ciprofloxacin Ciprofloxacin Hydrochloride | — Medicare Part D | — | — | — |
| UZEDY risperidone | — Medicare Part D | — | — | — |
| Obagi Nu-Derm System Normal-Dry Skin Transformation Kit Hydroquinone, Homosalate, Octisalate, Zinc Oxide | — Medicare Part D | — | — | — |
| EVRYSDI Risdiplam | — Medicare Part D | — | — | — |
| PCXX COOL PEPPERMINT APF G Sodium Fluoride | — Medicare Part D | — | — | — |
| VALSARTAN AND HYDROCHLOROTHIAZIDE Valsartan and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Desmopressin Acetate Desmopressin Acetate | — Medicare Part D | — | — | — |
| GLYDO- lidocaine hydrochloride jelly GLYDO- lidocaine hydrochloride jelly | — Medicare Part D | — | — | — |
| XENPOZYME olipudase alfa-rpcp | — Medicare Part D | — | — | — |
| Deferasirox oral Deferasirox | — Medicare Part D | — | — | — |
| Siliq Brodalumab | — Medicare Part D | Yes | — | — |
| AcetaZOLAMIDE acetazolamide | — Medicare Part D | — | — | — |
| Armodafinil armodafinil | — Medicare Part D | — | — | — |
| Diazoxide Diazoxide | — Medicare Part D | — | — | — |
| Calcium Acetate Calcium Acetate | — Medicare Part D | — | — | — |
| Ezetimibe EZETIMIBE | — Medicare Part D | — | — | — |
| Lidothol lidocaine and menthol | — Medicare Part D | — | — | — |
| RIVASTIGMINE TARTRATE RIVASTIGMINE TARTRATE | — Medicare Part D | — | — | — |
| COLLAGENASE SANTYL COLLAGENASE SANTYL | — Medicare Part D | — | — | — |
| Gralise gabapentin | — Medicare Part D | — | — | — |
| Verapamil Hydrochloride verapamil hydrochloride | — Medicare Part D | — | — | — |
| Neo-Synalar neomycin sulfate and fluocinolone acetonide | — Medicare Part D | — | — | — |