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 |
|---|---|---|---|---|
| Nutropin AQ NuSpin 10, Nutropin AQ NuSpin 5, Nutropin AQ NuSpin 20 | — Medicare Part D | — | — | — |
| METFORMIN HYDROCHLORIDE metformin hydrochloride | — Medicare Part D | — | — | — |
| E.E.S 400, E.E.S | — Medicare Part D | — | — | — |
| SERTRALINE HYDROCHLORIDE Sertraline Hydrochloride | — Medicare Part D | — | — | — |
| Air Air | — Medicare Part D | — | Step therapy | — |
| Gloperba Colchicine | — Medicare Part D | — | — | — |
| Sotalol Sotalol Hydrochloride | — Medicare Part D | — | — | — |
| MYQORZO AFICAMTEN | — Medicare Part D | — | — | — |
| OBAGI C RX system C CLARIFYING SERUM HYDROQUINONE | — Medicare Part D | — | — | — |
| ASCENIV HUMAN IMMUNOGLOBULIN G | — Medicare Part D | — | — | — |
| Cuprimine penicillamine | — Medicare Part D | — | — | — |
| DULOXETINE Duloxetine | — Medicare Part D | — | — | — |
| Daytrana methylphenidate | — Medicare Part D | — | — | — |
| Selarsdi ustekinumab-aekn | — Medicare Part D | — | — | — |
| Celontin methsuximide | — Medicare Part D | — | — | — |
| Kerendia finerenone | — Medicare Part D | — | — | — |
| Latuda lurasidone hydrochloride | — Medicare Part D | — | — | — |
| Me NaPhos MB Hyo 1 Urinary Antiseptic Antispasmodic | — Medicare Part D | — | — | — |
| Ammonia N-13 ammonia n-13 | — Medicare Part D | — | — | — |
| Kit for the Preparation of Technetium Tc 99m Medronate Kit For The Preparation Of Technetium Tc 99m Medronate | — Medicare Part D | — | — | — |
| Fyremadel ganirelix acetate | — Medicare Part D | — | — | — |
| Corlanor ivabradine | — Medicare Part D | — | — | — |
| ESTRADIOL VALERATE Estradiol Valerate | — Medicare Part D | — | — | — |
| NEREUS | — Medicare Part D | — | — | — |
| MLK Kit F2 marcaine, lidocaine, kenalog, povidone iodine | — Medicare Part D | — | — | — |
| Ontralfy Tizanidine Hydrochloride | — Medicare Part D | — | — | — |
| Aminosyn II ISOLEUCINE, LEUCINE, LYSINE ACETATE, METHIONINE, PHENYLALANINE, THREONINE, TRYPTOPHAN, VALINE, ALANINE, ARGININE, ASPARTIC ACID, GLUTAMIC ACID, HISTIDINE, PROLINE, SERINE, N-ACETYLTYROSINE, and GLYCINE | — Medicare Part D | — | — | — |
| FASENRA Benralizumab | — Medicare Part D | Yes | — | — |
| Buprenorphine and Naloxone Sublingual Film Buprenorphine and Naloxone | — Medicare Part D | — | — | — |
| ZITUVIMET Sitagliptin and Metformin Hydrochloride | — Medicare Part D | — | — | — |
| HICON Sodium Iodide I 131 | — Medicare Part D | — | — | — |
| ICATIBANT Icatibant | — Medicare Part D | — | — | — |
| Zokinvy lonafarnib | — Medicare Part D | — | — | — |
| LAMIVUDINE AND ZIDOVUDINE Lamivudine and Zidovudine | — Medicare Part D | — | — | — |
| ACULAR LS Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| EVEROLIMUS Everolimus | — Medicare Part D | — | — | — |
| Flavoxate Hydrochloride Flavoxate Hydrochloride | — Medicare Part D | — | — | — |
| CAFCIT caffeine citrate | — Medicare Part D | — | — | — |
| Mardex 25 Kit Dexamethasone Sodium Phosphate, Bupivacaine Hydrochloride, Povidine Iodine | — Medicare Part D | — | — | — |
| Oxiconazole Nitrate Oxiconazole Nitrate | — Medicare Part D | — | — | — |
| Aldactone spironolactone | — Medicare Part D | — | — | — |
| Iclusig ponatinib hydrochloride | — Medicare Part D | — | — | — |
| Perikabiven Dextrose, Soybean oil, Electrolytes, Lysine, Phenylalanine, Leucine, Valine, Threonine, Methionine, Isoleucine, Tryptophan, Alanine, Arginine, Glycine, Proline, Histidine, Glutamic Acid, Serine, Aspartic Acid and Tyrosine | — Medicare Part D | — | — | — |
| Celexa citalopram | — Medicare Part D | — | — | — |
| NATPARA (parathyroid hormone) PARATHYROID HORMONE | — Medicare Part D | — | — | — |
| TASCENSO ODT Fingolimod Lauryl Sulfate | — Medicare Part D | — | — | — |
| LANREOTIDE ACETATE lanreotide acetate | — Medicare Part D | — | — | — |
| DABIGATRAN ETEXILATE dabigatran etexilate | — Medicare Part D | — | — | — |
| buprenorphine transdermal system buprenorphine | — Medicare Part D | — | — | — |
| Phenelzine Sulfate PHENELZINE SULFATE | — Medicare Part D | — | — | — |