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 |
|---|---|---|---|---|
| BUTALBITAL AND ACETAMINOPHEN butalbital and acetaminophen | — Medicare Part D | — | — | — |
| PHYTONADIONE Phytonadione | — Medicare Part D | — | — | — |
| UVADEX Methoxsalen | — Medicare Part D | — | — | — |
| Fulvestrant Fulvestrant | — Medicare Part D | — | — | — |
| DORZOLAMIDE HYDROCHLORIDE TIMOLOL MALEATE dorzolamide hydrochloride timolol maleate | — Medicare Part D | — | — | — |
| AMOXICILLIN AND CLAVULANATE POTASSIUM Amoxicillin and Clavulanate Potassium | — Medicare Part D | — | — | — |
| Mixed Salts of a Single Entity Amphetamine Product XR Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate | — Medicare Part D | — | — | — |
| CEFAZOLIN Cefazolin | — Medicare Part D | — | — | — |
| ZILXI Minocycline | — Medicare Part D | — | — | — |
| VANCOMYCIN HYDROCHLORIDE Vancomycin Hydrochloride | — Medicare Part D | — | — | — |
| Losartan Potassium losartan potassium and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Sterile Cord Blood Collection Unit (MSC128D) Sterile Cord Blood Collection Unit | — Medicare Part D | — | — | — |
| Inrebic Fedratinib Hydrochloride | — Medicare Part D | — | — | — |
| PreviDent 5000 Plus Fruitastic, PreviDent 5000 Plus Spearmint | — Medicare Part D | — | — | — |
| ORPHENADRINE CITRATE Orphenadrine citrate | — Medicare Part D | — | — | — |
| Doxylamine Succinate and Pyridoxine Hydrochloride Doxylamine succinate and pyridoxine hydrochloride | — Medicare Part D | — | — | — |
| Escitalopram Escitalopram Oxalate | — Medicare Part D | — | — | — |
| XGEVA denosumab | — Medicare Part D | Yes | — | — |
| Aminosyn-PF ISOLEUCINE, LEUCINE, LYSINE ACETATE, METHIONINE, PHENYLALANINE, THREONINE, TRYPTOPHAN, VALINE, ALANINE, ARGININE, ASPARTIC ACID, GLUTAMIC ACID, GLYCINE, HISTIDINE, PROLINE, SERINE, TAURINE, and TYROSINE | — Medicare Part D | — | — | — |
| E-Z-Paste Barium Sulfate | — Medicare Part D | — | — | — |
| ZERBAXA ceftolozane and tazobactam | — Medicare Part D | Yes | — | — |
| Perforomist formoterol fumarate dihydrate | — Medicare Part D | — | — | — |
| Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, Amphetamine Sulfate Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, Amphetamine Sulfate | — Medicare Part D | — | — | — |
| AMANTADINE HYDROCHLORIDE Amantadine Hydrochloride | — Medicare Part D | — | — | — |
| Polyethylene Glycol 3350 and electrolytes - Unflavored, Polyethylene Glycol 3350 and electrolytes with Lemon Flavor, Polyethylene Glycol 3350 and electrolyteswith Orange Flavor | — Medicare Part D | — | — | — |
| Esomeprazole Magnesium esomeprazole magnesium | — Medicare Part D | — | — | — |
| Sulfacetamide Sodium SULFACETAMIDE SODIUM | — Medicare Part D | — | — | — |
| Clobex Clobetasol Propionate | — Medicare Part D | — | — | — |
| Lidothol Gel lidocaine and menthol | — Medicare Part D | — | — | — |
| LOPRESSOR metoprolol tartrate | — Medicare Part D | — | — | — |
| Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate Extended-Release DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, and AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| CLEMASTINE FUMARATE Clemastine Fumarate | — Medicare Part D | — | — | — |
| ZENATANE ISOTRETINOIN | — Medicare Part D | — | — | — |
| CONCERTA Methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| Pirfenidone Pirfenidone | — Medicare Part D | — | — | — |
| Flac Otic Oil fluocinolone acetonide | — Medicare Part D | — | — | — |
| Amantadine HCl Amantadine HCL | — Medicare Part D | — | — | — |
| Quinapril and Hydrochlorothiazide 10/12.5, Quinapril and Hydrochlorothiazide 20/12.5, Quinapril and Hydrochlorothiazide 20/25 | — Medicare Part D | — | — | — |
| SHAROBEL Norethindrone | — Medicare Part D | — | — | — |
| PLERIXAFOR plerixafor | — Medicare Part D | — | — | — |
| Moexipril Hydrochloride Moexipril Hydrochloride | — Medicare Part D | — | — | — |
| Tretinoin Tretinoin | — Medicare Part D | — | — | — |
| Auryxia ferric citrate | — Medicare Part D | — | — | — |
| REXTOVY Naloxone Hydrochloride | — Medicare Part D | — | — | — |
| LEVONORGESTREL AND ETHINYL ESTRADIOL AND ETHINYL ESTRADIOL levonorgestrel and ethinyl estradiol and ethinyl estradiol | — Medicare Part D | — | — | — |
| NITROGLYCERIN Nitroglycerin | — Medicare Part D | — | — | — |
| Depo-Testosterone testosterone cypionate | — Medicare Part D | — | — | — |
| Verkazia cyclosporine | — Medicare Part D | — | — | — |
| AFREZZA INSULIN HUMAN | — Medicare Part D | — | — | — |
| Burkhart Neutral pH Sodium Fluoride | — Medicare Part D | — | — | — |