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 |
|---|---|---|---|---|
| AAGYLUR Penicillamine | — Medicare Part D | — | — | — |
| Halog Halcinonide Cream | — Medicare Part D | — | — | — |
| Aminophylline Aminophylline | — Medicare Part D | — | — | — |
| OLMESARTAN MEDOXOMIL, AMLODIPINE and HYDROCHLOROTHIAZIDE Olmesartan medoxomil, amlodipine and hydrochlorothiazide | — Medicare Part D | — | — | — |
| NINLARO ixazomib | — Medicare Part D | — | — | — |
| Memantine Hydrochloride Memantine Hydrochloride | — Medicare Part D | — | — | — |
| Hailey Fe 1.5/30 Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| TAGRISSO osimertinib | — Medicare Part D | — | — | — |
| Norepinephrine Bitartrate Norepinephrine bitartrate | — Medicare Part D | — | — | — |
| Olfoxacin Otic Soln Olfoxacin Otic Soln | — Medicare Part D | — | — | — |
| Amoxicillin/Clav Pot Amoxicillin/Clav Pot | — Medicare Part D | — | — | — |
| Diatrol vitamins and mineral | — Medicare Part D | — | — | — |
| Multivitamin with Fluoride Sodium Fluoride | — Medicare Part D | — | — | — |
| ZEJULA niraparib | — Medicare Part D | — | — | — |
| Mirabegron, Mirabgeorn | — Medicare Part D | — | — | — |
| Abiraterone Acetate, ABIRATERONE ACETATE | — Medicare Part D | — | — | — |
| Hydrocortisone and Acetic Acid Hydrocortisone and Acetic Acid | — Medicare Part D | — | — | — |
| ustekinumab ustekinumab | — Medicare Part D | — | — | — |
| NOVOLOG insulin aspart | — Medicare Part D | — | — | — |
| Inflamex Multivitamin | — Medicare Part D | — | — | — |
| Phenobarbital Oral Solution phenobarbital | — Medicare Part D | — | — | — |
| Gentamicin Sulfate Opth Solution Gentamicin Sulfate Opth Solution | — Medicare Part D | — | — | — |
| Levocetirizine Dihydrochloride levocetirizine Dihydrochloride | — Medicare Part D | — | — | — |
| LAMIVUDINE AND ZIDOVUDINE Lamivudine and Zidovudine | — Medicare Part D | — | — | — |
| Oxygen-Nitrogen Mixture Oxygen-Nitrogen Mixture | — Medicare Part D | — | — | — |
| ZINC SULFATE Zinc Sulfate Injection | — Medicare Part D | — | — | — |
| OXALIPLATIN Oxaliplatin | — Medicare Part D | — | — | — |
| Fluocinolone Acetonide Oil Fluocinolone Acetonide | — Medicare Part D | — | — | — |
| DECITABINE Decitabine | — Medicare Part D | — | — | — |
| Phenobarbital, Hyoscyamine Sulfate, Atropine Sulfate, Scopolamine Hydrobromide PHENOBARBITAL, HYOSCYAMINE SULFATE, ATROPINE SULFATE, SCOPOLAMINE HYDROBROMIDE | — Medicare Part D | — | — | — |
| ZEVTERA ceftobiprole medocaril sodium | — Medicare Part D | Yes | — | — |
| Nicotinamide Nicotinamide Adenine Dinucleotide (NAD) | — Medicare Part D | — | — | — |
| EXPAREL bupivacaine | — Medicare Part D | — | — | — |
| Amlodipine besylate and Olmesartan medoxomil amlodipine besylate and olmesartan medoxomil | — Medicare Part D | — | — | — |
| LIRAGLUTIDE Liraglutide | — Medicare Part D | — | — | — |
| Divalproex Sodium Divalproex Sodium | — Medicare Part D | — | — | — |
| Cytotec misoprostol | — Medicare Part D | — | — | — |
| Alvesco ciclesonide | — Medicare Part D | — | — | — |
| Isopto Atropine atropine sulfate | — Medicare Part D | — | — | — |
| EMEND aprepitant | — Medicare Part D | — | — | — |
| Escitalopram Oxalate Escitalopram Oxalate | — Medicare Part D | — | — | — |
| TZIELD teplizumab-mzwv | — Medicare Part D | — | — | — |
| KETOROLAC TROMETHAMINE Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| Cinacalcet Hydrochloride Cinacalcet Hydrochloride | — Medicare Part D | — | — | — |
| AMIODARONE HYDROCHLORIDE Amiodarone hydrochloride | — Medicare Part D | — | — | — |
| Omeprazole/Sodiium Bicarbonate Omeprazole/Sodiium Bicarbonate | — Medicare Part D | — | — | — |
| Tenofovir Disoproxil Fumarate TENOFOVIR DISOPROXIL FUMARATE | — Medicare Part D | — | — | — |
| NITROFURANTOIN NITROFURANTOIN | — Medicare Part D | — | — | — |
| Sulfameth/Trimeth-DS Sulfameth/Trimeth-DS | — Medicare Part D | — | — | — |
| IBANDRONATE SODIUM Ibandronate sodium | — Medicare Part D | — | — | — |