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 |
|---|---|---|---|---|
| Denta 5000 Plus Sensitive Sodium fluoride and Potassium nitrate | — Medicare Part D | — | — | — |
| LIDOCAINE AND PRILOCAINE LIDOCAINE AND PRILOCAINE LIDOCAINE AND PRILOCAINE | — Medicare Part D | — | — | — |
| INFED Iron Dextran | — Medicare Part D | — | — | — |
| DILTIAZEM HCI DILTIAZEM HCI | — Medicare Part D | — | — | — |
| Nifedipine ER Nifedipine | — Medicare Part D | — | — | — |
| Moxifloxacin Ophthalmic Solution Moxifloxacin ophthalmic | — Medicare Part D | — | — | — |
| Levetiracetam, Roweepra | — Medicare Part D | — | — | — |
| Indium In 111 Oxyquinoline Indium In-111 Oxyquinoline | — Medicare Part D | — | — | — |
| SELEGILINE HYDROCHLORIDE Selegiline Hydrochloride | — Medicare Part D | — | — | — |
| ENTECAVIR entecavir | — Medicare Part D | — | — | — |
| LIDOCAINE HCI Lidocaine HCI | — Medicare Part D | — | — | — |
| Definity perflutren | — Medicare Part D | — | — | — |
| PredniSONE Tablets, USP, 20 mg | — Medicare Part D | — | — | — |
| Prednisone D/P Prednisone D/P | — Medicare Part D | — | — | — |
| GADOTERIDOL GADOTERIDOL | — Medicare Part D | — | — | — |
| FLEQSUVY baclofen | — Medicare Part D | — | — | — |
| STYPTSTIX SILVER NITRATE APPLICATOR | — Medicare Part D | — | — | — |
| Bromfenac Ophthalmic Solution, 0.07% | — Medicare Part D | — | — | — |
| Dexrazoxane Dexrazoxane for Injection | — Medicare Part D | — | — | — |
| Epinephrine EPINEPHRINE | — Medicare Part D | — | — | — |
| Etonogestrel/Ethinyl Estradiol etonogestrel and ethinyl estradiol | — Medicare Part D | — | — | — |
| Sevelamer Hydrochloride Sevelamer Hydrochloride | — Medicare Part D | — | — | — |
| Bupropion HCL Bupropion HCL | — Medicare Part D | — | — | — |
| AMLODIPINE AND OLMESARTAN MEDOXOMIL Amlodipine and Olmesartan Medoxomil | — Medicare Part D | — | — | — |
| ALBUTEROL SULFATE ALBUTEROL SULFATE | — Medicare Part D | — | — | — |
| Gemcitabine hydrochloride Gemcitabine Hydrochloride | — Medicare Part D | — | — | — |
| Clindamycin Phoaphate Topical USP, 1% | — Medicare Part D | — | — | — |
| ONDANSETRON Ondansetron | — Medicare Part D | — | — | — |
| Valganciclovir hydrochloride for Oral Valganciclovir hydrochloride | — Medicare Part D | — | — | — |
| DUAKLIR PRESSAIR aclidinium bromide and formoterol fumarate | — Medicare Part D | — | — | — |
| MYDAYIS DEXTROAMPHETAMINE SULFATE, DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, and AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| BUPIVACAINE HYDROCHLORIDE BUPIVACAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Timolol Hemihydrate TIMOLOL HEMIHYDRATE | — Medicare Part D | — | — | — |
| Trazimera trastuzumab-qyyp | — Medicare Part D | — | — | — |
| Clindacin ETZ clindamycin phosphate | — Medicare Part D | — | — | — |
| Afirmelle Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Calcium Gluconate Calcium Gluconate | — Medicare Part D | — | — | — |
| NEOMYCIN POLYMYXIN B SULFATES AND DEXAMETHASONE Neomycin sulfate, Polymyxin B Sulfate and Dexamethasone | — Medicare Part D | — | — | — |
| Fexinidazole Fexinidazole | — Medicare Part D | — | — | — |
| LEQVIO inclisiran | — Medicare Part D | — | — | — |
| LOPERAMIDE HYDROCHLORIDE Loperamide Hydrochloride | — Medicare Part D | — | — | — |
| Hydroxyzine Pamoate hydroxyzine pamoate | — Medicare Part D | — | — | — |
| BUPROPION HYDROCHLORIDE SR bupropion hydrochloride | — Medicare Part D | — | — | — |
| Travoprost Ophthalmic Solution Travoprost Ophthalmic Solution | — Medicare Part D | — | — | — |
| AZELASTINE HYDROCHLORIDE AND FLUTICASONE PROPIONATE Azelastine hydrochloride and Fluticasone propionate | — Medicare Part D | — | — | — |
| MYCOPHENOLATE MOFETIL Mycophenolate Mofetil | — Medicare Part D | — | — | — |
| Pazopanib pazopanib hydrochloride | — Medicare Part D | — | — | — |
| BYNFEZIA Pen octreotide acetate | — Medicare Part D | — | — | — |
| Methadone Hydrocloride dye-free, sugar-free, unflavored methadone hydrochloride | — Medicare Part D | — | — | — |
| SOMATULINE DEPOT lanreotide acetate | — Medicare Part D | — | — | — |