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 |
|---|---|---|---|---|
| Nateglinide Nateglinide | — Medicare Part D | — | — | — |
| Dobutamine dobutamine | — Medicare Part D | — | — | — |
| Lactated Ringers and Dextrose, Lactated Ringers | — Medicare Part D | — | — | — |
| Alunbrig brigatinib | — Medicare Part D | — | — | — |
| Steritalc 2g, Steritalc 3g, Steritalc 4g | — Medicare Part D | — | — | — |
| Abacavir Sulfate abacavir sulfate | — Medicare Part D | — | — | — |
| Perphenazine and Amitriptyline Hydrochloride perphenazine and amitriptyline hydrochloride | — Medicare Part D | — | — | — |
| Triamcinolone acetonide, TRIAMCINOLONE ACETONIDE | — Medicare Part D | — | — | — |
| Promethazine Hydrochloride and Phenylephrine Hydrochloride Promethazine and Phenylephrine | — Medicare Part D | — | — | — |
| ZEPOSIA 7-Day Starter Pack, ZEPOSIA, ZEPOSIA Starter Kit | — Medicare Part D | — | — | — |
| NUBEQA darolutamide | — Medicare Part D | — | — | — |
| Aczone dapsone | — Medicare Part D | — | — | — |
| MONTELUKAST Montelukast | — Medicare Part D | — | — | — |
| DIFLUPREDNATE Difluprednate | — Medicare Part D | — | — | — |
| Demeclocycline Hydrochloride Demeclocycline | — Medicare Part D | — | — | — |
| Gelato Neutral pH Sodium Fluoride | — Medicare Part D | — | — | — |
| CEQUA cyclosporine | — Medicare Part D | — | — | — |
| Piperacillin, Tazobactam Piperacillin Sodium, Tazobactam Sodium | — Medicare Part D | — | — | — |
| Varenicline VARENICLINE | — Medicare Part D | — | — | — |
| Nitroglycerin In Dextrose Nitroglycerin | — Medicare Part D | — | — | — |
| Sodium Fluoride 5000 ppm Fruit, Sodium Fluoride 5000 ppm Spearmint | — Medicare Part D | — | — | — |
| AMOXICILLIN AND CLAVULANATE POTASSIUM Amoxicillin and Clavulanate Potassium | — Medicare Part D | — | — | — |
| Xarelto, XARELTO | — Medicare Part D | — | — | — |
| POTASSIUM PHOSPHATES Potassium Phosphate, Monobasic Potassium Phosphate, Dibasic | — Medicare Part D | — | — | — |
| Vilazodone Hydrochloride, Vilazodone hydrochloride | — Medicare Part D | — | — | — |
| Varibar Nectar barium sulfate | — Medicare Part D | — | — | — |
| Sorafenib Tosylate Sorafenib Tosylate | — Medicare Part D | — | — | — |
| Phenazopyridine Hydrochloride PHENAZOPYRIDINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Livtencity MARIBAVIR | — Medicare Part D | — | — | — |
| Fyavolv Norethindrone Acetate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| CHOLESTYRAMINE cholestyramine | — Medicare Part D | — | — | — |
| Drospirenone/Ethinyl Estradiol/Levomefolate Calcium and Levomefolate Calcium Drospirenone/ethinyl estradiol/levomefolate calcium and levomefolate calcium | — Medicare Part D | — | — | — |
| PRUDOXIN doxepin hydrochloride | — Medicare Part D | — | — | — |
| Norepinephrine Bitartrate Norepinephrine bitartrate | — Medicare Part D | — | — | — |
| OFLOXACIN ofloxacin | — Medicare Part D | — | — | — |
| LUCENTIS RANIBIZUMAB | — Medicare Part D | — | — | — |
| Vitafol One Prenatal Supplement with DHA | — Medicare Part D | — | — | — |
| DEXMETHYLPHENIDATE HYDROCHLORIDE Dexmethylphenidate Hydrochloride | — Medicare Part D | — | — | — |
| Paxlovid nirmatrelvir and ritonavir | — Medicare Part D | — | — | — |
| Prilosec omeprazole magnesium | — Medicare Part D | — | — | — |
| Mulpleta Lusutrombopag | — Medicare Part D | — | — | — |
| Photofrin Porfimer Sodium | — Medicare Part D | — | — | — |
| Adapalene ADAPALENE | — Medicare Part D | — | — | — |
| TELMISARTAN AND HYDROCHLOROTHIAZIDE Telmisartan and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Talzenna talazoparib | — Medicare Part D | — | — | — |
| VYKAT XR diazoxide choline | — Medicare Part D | — | — | — |
| Tridesilon Cream desonide 0.05% | — Medicare Part D | — | — | — |
| Mycophenolate Mofetil, mycophenolate mofetil | — Medicare Part D | — | — | — |
| ELUCIREM gadopiclenol | — Medicare Part D | — | — | — |
| Teriparatide Teriparatide | — Medicare Part D | — | — | — |