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 |
|---|---|---|---|---|
| Sodium Sulfacetamide 10% and Sulfur 2% Cleanser SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| ORFADIN Nitisinone | — Medicare Part D | — | — | — |
| SULFAMYLON mafenide acetate | — Medicare Part D | — | — | — |
| Istalol Timolol Maleate | — Medicare Part D | — | — | — |
| Positive Skin Test Control - Histamine Histamine | — Medicare Part D | — | — | — |
| Photrexa Cross-linking Kit riboflavin 5-phosphate ophthalmic | — Medicare Part D | — | — | — |
| PRENATE DHA ascorbic acid, cholecalciferol, .alpha.-tocopherol, dl-, folic acid, pyridoxine hydrochloride, cyanocobalamin, calcium formate, ferrous asparto glycinate, magnesium oxide and doconexent | — Medicare Part D | — | — | — |
| SODIUM SULFACETAMIDE 10% AND SULFUR 5% Emollient Cream SODIUM SULFACETAMIDE 10% AND SULFUR 5% Emollient Cream | — Medicare Part D | — | — | — |
| Droperidol DROPERIDOL | — Medicare Part D | — | — | — |
| XULANE norelgestromin and ethinyl estradiol | — Medicare Part D | — | — | — |
| CEFPROZIL Cefprozil | — Medicare Part D | — | — | — |
| Sufentanil Citrate SUFENTANIL CITRATE | — Medicare Part D | — | — | — |
| Isosorbide dinitrate and hydralazine hydrochloride isosorbide dinitrate and hydralazine hydrochloride | — Medicare Part D | — | — | — |
| TIZANIDINE HYDROCHLORIDE tizanidine hydrochloride | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 9.8 % and Sulfur 4.8 % Cleanser Sodium Sulfacetamide and Sulfur | — Medicare Part D | — | — | — |
| Memantine and Donepezil Hydrochlorides Extended-release Memantine and Donepezil | — Medicare Part D | — | — | — |
| ONDANSETRON Ondansetron | — Medicare Part D | — | — | — |
| Carbamazepine Carbamazepine | — Medicare Part D | — | — | — |
| Reclipsen 28 Day Desogestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE | — Medicare Part D | — | — | — |
| TOFIDENCE Tocilizumab | — Medicare Part D | — | — | — |
| Ryzumvi phentolamine mesylate | — Medicare Part D | — | — | — |
| OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE Olmesartan Medoxomil and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| ENTECAVIR entecavir | — Medicare Part D | — | — | — |
| PERJETA Pertuzumab | — Medicare Part D | — | — | — |
| Alcaine proparacaine hydrochloride | — Medicare Part D | — | — | — |
| COLESEVELAM HYDROCHLORIDE Colesevelam hydrochloride | — Medicare Part D | — | — | — |
| ORMALVI Dichlorphenamide | — Medicare Part D | — | — | — |
| IBUPROFEN AND FAMOTIDINE Ibuprofen and famotidine | — Medicare Part D | — | — | — |
| Halobetasol Propionate Halobetasol Propionate | — Medicare Part D | — | — | — |
| SAPROPTERIN DIHYDROCHLORIDE sapropterin dihydrochloride | — Medicare Part D | — | — | — |
| Mefenamic Acid Mefenamic Acid | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 9% and Sulfur 4.5% Cleanser SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| Doxycyclate Hyclate Doxycycline Hyclate | — Medicare Part D | — | — | — |
| Naprelan Naproxen Sodium | — Medicare Part D | — | — | — |
| FENOFIBRIC ACID Fenofibric Acid | — Medicare Part D | — | — | — |
| Zorcaine Articaine Hydrochloride and Epinephrine | — Medicare Part D | — | — | — |
| Provocholine, Provocholine Inhalation Solution | — Medicare Part D | — | — | — |
| OHM-RESB Aconitum, Aranea, Bryonia, Equisetum, Eupatorium Perf, Hydrastis, Juglans Reg, Kali Bic, Phosphorus, Sarsaparrilla, Sulphur | — Medicare Part D | — | — | — |
| AMLODIPINE BESYLATE Amlodipine Besylate | — Medicare Part D | — | — | — |
| Cleocin Phosphate clindamycin phosphate | — Medicare Part D | — | — | — |
| Diclofenac Epolamine Diclofenac Epolamine | — Medicare Part D | — | — | — |
| Cisatracurium Besylate Cisatracurium besylate | — Medicare Part D | — | — | — |
| Burkhart Sodium Fluoride | — Medicare Part D | — | — | — |
| Apretude Cabotegravir | — Medicare Part D | — | — | — |
| SALICYLIC ACID Salicylic Acid | — Medicare Part D | — | — | — |
| Survanta Beractant | — Medicare Part D | — | — | — |
| Medical Air AIR | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 8% and Sulfur 4% SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| Hailey 24 Fe norethindrone acetate and ethinyl estradiol, and ferrous fumarate | — Medicare Part D | — | — | — |