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 |
|---|---|---|---|---|
| Teriflunomide Teriflunomide | — Medicare Part D | — | — | — |
| Oriahnn Elagolix and Estradiol and Norethisterone | — Medicare Part D | — | — | — |
| Lisinopril Lisinopril | — Medicare Part D | — | — | — |
| Bendamustine Hydrochloride BENDAMUSTINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Erythromycin and Benzoyl Peroxide Erythromycin and Benzoyl Peroxide | — Medicare Part D | — | — | — |
| Tolvaptan Tolvaptan | — Medicare Part D | — | — | — |
| FLUOCINONIDE FLUOCINONIDE | — Medicare Part D | — | — | — |
| Levoleucovorin Levoleucovorin | — Medicare Part D | — | — | — |
| GATIFLOXACIN GATIFLOXACIN | — Medicare Part D | — | — | — |
| CLOTRIMAZOLE Clotrimazole | — Medicare Part D | — | — | — |
| INSULIN DILUTING MEDIUM FOR Kirsty, KIRSTY | — Medicare Part D | Yes | — | — |
| Wixela Inhub fluticasone propionate and salmeterol | — Medicare Part D | — | — | — |
| Sodium Fluoride F18 Sodium Fluoride F18 | — Medicare Part D | — | — | — |
| Levalbuterol Levalbuterol | — Medicare Part D | — | — | — |
| Trimipramine Maleate TRIMIPRAMINE MALEATE | — Medicare Part D | — | — | — |
| Colesevelam Colesevelam HCL | — Medicare Part D | — | — | — |
| Galantamine Hydrobromide Galantamine Hydrobromide | — Medicare Part D | — | — | — |
| QALSODY tofersen | — Medicare Part D | — | — | — |
| Hydrochlorothiazide Hydrochlorothiazide | — Medicare Part D | — | — | — |
| DROSPIRENONE AND ETHINYL ESTRADIOL Drospirenone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| SODIUM IODIDE I 123 Sodium Iodide I 123 | — Medicare Part D | — | — | — |
| Carbaglu Carglumic Acid | — Medicare Part D | — | — | — |
| Venclexta Venetoclax | — Medicare Part D | — | — | — |
| Olanzapine Olanzapine | — Medicare Part D | — | — | — |
| ZONISADE ZONISAMIDE | — Medicare Part D | — | — | — |
| ENFLONSIA CLESROVIMAB | — Medicare Part D | — | — | — |
| IZERVAY avacincaptad pegol | — Medicare Part D | — | — | — |
| Fesoterodine Fumarate FESOTERODINE FUMARATE | — Medicare Part D | — | — | — |
| Cartia XT Diltiazem Hydrochloride | — Medicare Part D | — | — | — |
| Clindamycin Phoaphate Topical Solution USP, 1% | — Medicare Part D | — | — | — |
| CHLORZOXAZONE CHLORZOXAZONE | — Medicare Part D | — | — | — |
| DANZITEN nilotinib | — Medicare Part D | — | — | — |
| Tiagabine Hydrochloride Tiagabine Hydrochloride | — Medicare Part D | — | — | — |
| CANDESARTAN CILEXETIL Candesartan Cilexetil | — Medicare Part D | — | — | — |
| Ztlido Lidocaine | — Medicare Part D | — | — | — |
| PROCYSBI Cysteamine bitartrate | — Medicare Part D | — | — | — |
| SULFADIAZINE sulfADIAZINE | — Medicare Part D | — | — | — |
| Ultratag RBC Kit for the Preparation of Technetium Tc 99m Red Blood Cells | — Medicare Part D | — | — | — |
| CANDESARTAN CILEXETIL Candesartan Cilexetil | — Medicare Part D | — | — | — |
| Hydrocodone/APAP Hydrocodone/APAP | — Medicare Part D | — | — | — |
| PHEBURANE Sodium phenylbutyrate | — Medicare Part D | — | — | — |
| Yuflyma adalimumab-aaty | — Medicare Part D | — | — | — |
| pioglitazone and glimepiride pioglitazone and glimepiride | — Medicare Part D | — | — | — |
| TREMFYA Guselkumab | — Medicare Part D | Yes | — | — |
| Keveyis Dichlorphenamide | — Medicare Part D | — | — | — |
| OXBRYTA Voxelotor | — Medicare Part D | — | — | — |
| Metoprolol Metoprolol tartrate | — Medicare Part D | — | — | — |
| Denti-Care Denti-Rinse Neutral Sodium Fluoride Oral Rinse | — Medicare Part D | — | — | — |
| NEUTRAMAXX 5000 PLUS TURBO SODIUM FLUORIDE | — Medicare Part D | — | — | — |
| LINCOMYCIN Lincomycin Hydrochloride | — Medicare Part D | — | — | — |