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 |
|---|---|---|---|---|
| DermacinRx Lidotral Lidocaine Hydrochloride | — Medicare Part D | — | — | — |
| Labetalol Hydrochloride Labetalol Hydrochloride | — Medicare Part D | — | — | — |
| NORETHINDRONE norethindrone acetate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Hyoscyamine Sulfate, Hyoscyamine sulfate, Hyoscyamine sulfate Sublingual | — Medicare Part D | — | — | — |
| DEFERASIROX Deferasirox | — Medicare Part D | — | — | — |
| Fludarabine Phosphate Fludarabine phosphate | — Medicare Part D | — | — | — |
| Oxygen Compressed Gas Oxygen Compressed Gas | — Medicare Part D | — | — | — |
| AZITHROMYCIN Azithromycin | — Medicare Part D | — | — | — |
| Junel FE Junel FE | — Medicare Part D | — | — | — |
| Dalbavancin dalbavancin hydrochloride | — Medicare Part D | — | — | — |
| Lofexidine hydrochloride Lofexidine Hydrochloride | — Medicare Part D | — | — | — |
| Aceticum acidum ACETICUM ACIDUM, ARNICA MONTANA, AVENA SATIVA, CALCAREA CARBONICA, CALCAREA PHOSPHORICA, CALCAREA SULPHURICA, CEANOTHUS AMERICANUS, CERATOSTIGMA ILLMOTTIANUM, CHININUM ARSENICOSUM, CITRICUM ACIDUM, ENGLISH ELM, EUROPEAN HORNBEAM, EUROPEAN OLIVE, GENTIANELLA AMARELLA, HYDROFLUORICUM ACIDUM, JUGLANS REGIA, LACTICUM ACIDUM, MAGNESIA PHOSPHORICA, NATRUM MURIATICUM, NATRUM PHOSPHORICUM, NATRUM SILICOFLUORICUM, NATRUM SULPHURICUM, PASSIFLORA INCARNATA, PHOSPHORICUM ACIDUM, SARCOLACTICUM ACIDUM, SOLIDAGO VIRGAUREA | — Medicare Part D | — | — | — |
| Vilazodone Hydrochloride vilazodone hydrochloride | — Medicare Part D | — | — | — |
| POTASSIUM CHLORIDE IN DEXTROSE Potassium Chloride and Dextrose Monohydrate | — Medicare Part D | — | — | — |
| Tolcapone Tolcapone | — Medicare Part D | — | — | — |
| ZELVYSIA SAPROPTERIN DIHYDROCHLORIDE | — Medicare Part D | — | — | — |
| Montelukast Sodium Montelukast Sodium | — Medicare Part D | — | — | — |
| Insulin Degludec insulin degludec | — Medicare Part D | Yes | — | — |
| Travoprost Ophthalmic Solution Travoprost Ophthalmic Solution | — Medicare Part D | — | — | — |
| Metoprolol Tartrate Metoprolol tartrate | — Medicare Part D | — | — | — |
| Prevalite cholestyramine | — Medicare Part D | — | — | — |
| LIDOCAINE HCl AND EPINEPHRINE LIDOCAINE HCl and EPINEPHRINE | — Medicare Part D | — | — | — |
| Almotriptan Malate Almotriptan Malate | — Medicare Part D | — | — | — |
| Zap APF Sodium Fluoride | — Medicare Part D | — | — | — |
| Glucose and Sodium Chloride Dextrose Anhydrous and Sodium Chloride | — Medicare Part D | — | — | — |
| ATROPEN Auto-Injector atropine | — Medicare Part D | — | — | — |
| DECITABINE Decitabine | — Medicare Part D | — | — | — |
| VIGAFYDE vigabatrin | — Medicare Part D | — | — | — |
| Safyral Drospirenone/ethinyl estradiol/levomefolate calcium and levomefolate calcium | — Medicare Part D | — | — | — |
| LURASIDONE HYDROCHLORIDE LURASIDONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| TERBINAFINE HYDROCHLORIDE Terbinafine Hydrochloride | — Medicare Part D | — | — | — |
| DULOXETINE DELAYED-RELEASE DULOXETINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Sterile Diluent for Treprostinil, Treprostinil | — Medicare Part D | — | — | — |
| Natesto nasal gel testosterone | — Medicare Part D | — | — | — |
| Betadine POVIDONE-IODINE | — Medicare Part D | — | — | — |
| COSELA trilaciclib | — Medicare Part D | — | — | — |
| Cetirizine Hydrochloride Oral Solution Cetirizine Hydrochloride | — Medicare Part D | — | — | — |
| Ammonium Lactate Ammonium Lactate | — Medicare Part D | — | — | — |
| Petroselinum sativum Berberis Vulgaris, Hydrangea Arborescens, Petroselinum Sativum, Solidago Virgaurea, Uva Ursi, Rubia Tinctorum, Glutathione, Kidney (Suis), Bryonia (Alba), Eupatorium Purpureum, Mercurius Corrosivus | — Medicare Part D | — | — | — |
| Basic Dental Emergency Kit Epinephrine, Albuterol Sulfate, Nitroglycerin, Diphenhydramine Hydrochloride, Aspirin | — Medicare Part D | — | — | — |
| Insulin Lispro Protamine and Insulin Lispro Injectable Suspension Mix75/25 KwikPen | — Medicare Part D | Yes | — | — |
| Cyclosporine Modified Cyclosporine | — Medicare Part D | — | — | — |
| Bonsity teriparatide | — Medicare Part D | — | — | — |
| KETOROLAC TROMETHAMINE Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| Brompheniramine maleate, pseudoephedrine hydrochloride, Brompheniramine Maleate, Pseudoephedrine Hydrochloride, and Dextromethorphan Hydrobromide | — Medicare Part D | — | — | — |
| MEMANTINE AND DONEPEZIL HYDROCHLORIDES Memantine and Donepezil | — Medicare Part D | — | — | — |
| CICLOPIROX Ciclopirox | — Medicare Part D | — | — | — |
| Valium diazepam | — Medicare Part D | — | — | — |
| Tikosyn dofetilide | — Medicare Part D | — | — | — |
| MARCAINE WITH EPINEPHRINE BUPIVACAINE HYDROCHLORIDE AND EPINEPHRINE | — Medicare Part D | — | — | — |