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 |
|---|---|---|---|---|
| Clindesse clindamycin phosphate | — Medicare Part D | — | — | — |
| SENSORCAINE(R) (BUPIVACAINE HCI AND EPINEPHRINE) BUPIVACAINE HYDROCHLORIDE and EPINEPHRINE BITARTRATE | — Medicare Part D | — | — | — |
| Anthim obiltoxaximab | — Medicare Part D | — | — | — |
| K Phos Neutral Sodium Phosphate, Dibasic, Anhydrous, Potassium Phosphate, Monobasic, and Sodium Phosphate, Monobasic, Monohydrate | — Medicare Part D | — | — | — |
| NESTABS DHA Prenatal Multi-vitamin/Mineral Supplement with DHA/EPA Sodium Ascorbate, Cholecalciferol, di-alpha-Tocopheryl Acetate, Thiamine Mononitrate, Riboflavin, Niacinamide, Pyridoxine HCL, Folic Acid, Cyanocobalamin, Calcium Formate, Calcium Carbonate, Ferrous (II) bis-Glycinate Chelate, Potassium Iodide, Zinc Oxide, Choline Bitartrate, with doconexent and icosapent | — Medicare Part D | — | — | — |
| DERMOTIC fluocinolone acetonide | — Medicare Part D | — | — | — |
| Iris 60 Second APF Sodium Fluoride | — Medicare Part D | — | — | — |
| Metolazone Metolazone | — Medicare Part D | — | — | — |
| Morphine Sulfate MORPHINE SULFATE | — Medicare Part D | — | — | — |
| Pentamidine Isethionate PENTAMIDINE ISETHIONATE | — Medicare Part D | — | — | — |
| Ovidrel choriogonadotropin alfa | — Medicare Part D | — | — | — |
| Silodosin Silodosin | — Medicare Part D | — | — | — |
| Just Right 5000 1.1% Sodium Fluoride Toothpaste | — Medicare Part D | — | — | — |
| Milnacipran hydrochloride, Savella | — Medicare Part D | — | — | — |
| Livdelzi SELADELPAR LYSINE | — Medicare Part D | — | — | — |
| Stribild elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate | — Medicare Part D | — | — | — |
| Methenamine Hippurate Methenamine hippurate | — Medicare Part D | — | — | — |
| CHROMIC CHLORIDE CHROMIC CHLORIDE | — Medicare Part D | — | — | — |
| VALSARTAN valsartan | — Medicare Part D | — | — | — |
| FeraBright Ferumoxytol | — Medicare Part D | — | — | — |
| TEZSPIRE tezepelumab-ekko | — Medicare Part D | — | — | — |
| AUGMENTIN ES-600 amoxicillin and clavulanate potassium | — Medicare Part D | — | — | — |
| Mirtazapine Mirtazapine | — Medicare Part D | — | — | — |
| TRIENTINE HYDROCHLORIDE TRIENTINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| LISDEXAMFETAMINE DIMESYLATE Lisdexamfetamine | — Medicare Part D | — | — | — |
| Atomoxetine Hydrochloride atomoxetine hydrochloride | — Medicare Part D | — | — | — |
| Daliresp roflumilast | — Medicare Part D | — | — | — |
| Duavee conjugated estrogens/bazedoxifene | — Medicare Part D | — | — | — |
| Renacidin citric acid, gluconolactone and magnesium carbonate | — Medicare Part D | — | — | — |
| IMULDOSA ustekinumab-srlf | — Medicare Part D | — | — | — |
| TOUJEO insulin glargine | — Medicare Part D | — | — | — |
| NEOMYCIN AND POLYMYXIN B SULFATES AND DEXAMETHASONE Neomycin Sulfate, Polymyxin B Sulfate, and Dexamethasone | — Medicare Part D | — | — | — |
| TICE BCG BACILLUS CALMETTE-GUERIN | — Medicare Part D | — | — | — |
| Altreno tretinoin | — Medicare Part D | — | — | — |
| Hetastarch in Sodium Chloride HETASTARCH | — Medicare Part D | — | — | — |
| Nabumetone Nabumetone | — Medicare Part D | — | — | — |
| SILDENAFIL CITRATE SILDENAFIL CITRATE | — Medicare Part D | — | — | — |
| Naproxen and esomeprazole magnesium Naproxen and esomeprazole magnesium | — Medicare Part D | — | — | — |
| Guanfacine Extended-Release guanfacine | — Medicare Part D | — | — | — |
| ELTROMBOPAG eltrombopag | — Medicare Part D | — | — | — |
| Amoxapine Amoxapine | — Medicare Part D | — | — | — |
| Trudhesa Dihydroergotamine mesylate | — Medicare Part D | — | — | — |
| MAGNESIUM SULFATE IN DEXTROSE Magnesium Sulfate | — Medicare Part D | — | — | — |
| Multitrace -4 Pediatric Trace Elements 4 | — Medicare Part D | — | — | — |
| Tobramycin Ophthalmic Solution Tobramycin Ophthalmic Solution | — Medicare Part D | — | — | — |
| Edex alprostadil | — Medicare Part D | — | — | — |
| Atomoxetine Atomoxetine | — Medicare Part D | — | — | — |
| Crataegus oxyacantha HAWTHORN LEAF WITH FLOWER | — Medicare Part D | — | — | — |
| Concept OB Vitamin Mineral Supplement | — Medicare Part D | — | — | — |
| Synagis palivizumab | — Medicare Part D | — | — | — |