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 |
|---|---|---|---|---|
| Nucynta tapentadol hydrochloride | — Medicare Part D | — | — | — |
| Fludeoxyglucose F18 Fludeoxyglucose F18 | — Medicare Part D | — | — | — |
| Tolectin tolmetin sodium | — Medicare Part D | — | — | — |
| Vilazodone Hydrochloride vilazodone hydrochloride | — Medicare Part D | — | — | — |
| TUKYSA tucatinib | — Medicare Part D | — | — | — |
| NITRO-DUR nitroglycerin | — Medicare Part D | — | — | — |
| METRONIDAZOLE Metronidazole | — Medicare Part D | — | — | — |
| XELODA capecitabine | — Medicare Part D | — | — | — |
| Brompheniramine, Pseudoephedrine, Dextromethorphan Brompheniramine, Pseudoephedrine, Dextromethorphan | — Medicare Part D | — | — | — |
| Lamotrigine Extended-Release lamotrigine extended-release | — Medicare Part D | — | — | — |
| Ferrlecit sodium ferric gluconate complex | — Medicare Part D | — | — | — |
| Nalbuphine Hydrochloride Nalbuphine Hydrochloride | — Medicare Part D | — | — | — |
| LIDOCAINE AND PRILOCAINE Lidocaine and Prilocaine | — Medicare Part D | — | — | — |
| PCXX WATERMELON APF G Sodium Fluoride | — Medicare Part D | — | — | — |
| Vytone HYDROCORTISONE ACETATE, IODOQUINOL | — Medicare Part D | — | — | — |
| Ketodan ketoconazole | — Medicare Part D | — | — | — |
| Enoxaparin Sodium enoxaparin sodium | — Medicare Part D | — | — | — |
| SymlinPen pramlintide acetate | — Medicare Part D | — | — | — |
| PACLITAXEL PROTEIN BOUND PARTICLES ALBUMIN BOUND Paclitaxel | — Medicare Part D | — | — | — |
| Klisyri tirbanibulin | — Medicare Part D | — | — | — |
| Atovaquone and Proguanil Hydrochloride Pediatric, Atovaquone and Proguanil Hydrochloride | — Medicare Part D | — | — | — |
| Gadobutrol Gadobutrol | — Medicare Part D | — | — | — |
| Norco Hydrocodone/APAP | — Medicare Part D | — | — | — |
| K-Phos No. 2 Potassium Phosphate, Monobasic and Sodium Phosphate, Monobasic, Anhydrous | — Medicare Part D | — | — | — |
| olmesartan medoxomil-hydrochlorothiazide olmesartan medoxomil-hydrochlorothiazide | — Medicare Part D | — | — | — |
| OGSIVEO nirogacestat | — Medicare Part D | — | — | — |
| POTASSIUM CITRATE Potassium Citrate | — Medicare Part D | — | — | — |
| Junel Fe 1.5/30 norethindrone acetate and ethinyl estradiol, and ferrous fumarate | — Medicare Part D | — | — | — |
| Aptiom ESLICARBAZEPINE ACETATE | — Medicare Part D | — | — | — |
| STROMECTOL ivermectin | — Medicare Part D | — | — | — |
| IRESSA Gefitinib | — Medicare Part D | — | — | — |
| Cilostazol Cilostazol | — Medicare Part D | — | — | — |
| PEG-3350, Electrolytes, and Ascorbate polyethylene glycol 3350, Sodium Sulfate, Sodium Chloride, Potassium Chloride, Sodium Ascorbate, and Ascorbic Acid | — Medicare Part D | — | — | — |
| Labetalol HCL Labetalol Hydrochloride | — Medicare Part D | — | — | — |
| GENOSYL nitric oxide | — Medicare Part D | — | — | — |
| DIPHENHYDRAMINE HYDROCHLORIDE Diphenhydramine Hydrochloride | — Medicare Part D | — | — | — |
| ergotamine tartrate and caffeine Ergotamine Tartrate and Caffeine | — Medicare Part D | — | — | — |
| Ribavirin Ribavirin | — Medicare Part D | — | — | — |
| AQVESME mitapivat | — Medicare Part D | — | — | — |
| SODIUM SULFACETAMIDE AND SULFUR Sodium Sulfacetamide and Sulfur | — Medicare Part D | — | — | — |
| Lasix FUROSEMIDE | — Medicare Part D | — | — | — |
| DEXTROAMPHETAMINE SULFATE DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| XELJANZ, XELJANZ XR | — Medicare Part D | Yes | — | — |
| Gastrografin diatrizoate meglumine and diatrizoate sodium | — Medicare Part D | — | — | — |
| RASAGILINE Rasagiline mesylate | — Medicare Part D | — | — | — |
| ADAPALENE AND BENZOYL PEROXIDE adapalene and benzoyl peroxide topical | — Medicare Part D | — | — | — |
| Nafcillin Nafcillin | — Medicare Part D | — | — | — |
| Mimvey Estradiol and Norethindrone Acetate | — Medicare Part D | — | — | — |
| Pentetate calcium trisodium pentetate calcium trisodium | — Medicare Part D | — | — | — |
| Carbatrol carbamazepine | — Medicare Part D | — | — | — |