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 |
|---|---|---|---|---|
| Mepivacaine Hydrochloride Mepivacaine Hydrochloride | — Medicare Part D | — | — | — |
| Levocetirizine Dihydrochloride levocetirizine Dihydrochloride | — Medicare Part D | — | — | — |
| Visudyne verteporfin for injection | — Medicare Part D | — | — | — |
| Icosapent Ethyl icosapent ethyl | — Medicare Part D | — | — | — |
| THYQUIDITY Levothyroxine Sodium | — Medicare Part D | — | — | — |
| Etravirine etravirine | — Medicare Part D | — | — | — |
| Docetaxel anhydrous Docetaxel Anhydrous | — Medicare Part D | — | — | — |
| MultiHance gadobenate dimeglumine | — Medicare Part D | — | — | — |
| LUMIGAN bimatoprost | — Medicare Part D | — | — | — |
| Rebyota Donor Human Stool | — Medicare Part D | — | — | — |
| Codeine Sulfate codeine sulfate | — Medicare Part D | — | — | — |
| Ferrum iodatum Chelidonium Majus, Iodium, Lycopus Virginicus, Ginkgo Biloba, Pinus Sylvestris, Fucus Vesiculosus, Spongia Tosta, Germanium Sesquioxide, Hypophysis Suis, Thyroidinum (Suis), Cysteinum, Manganese Gluconate, Alpha-Ketoglutaricum Acidum, Calcarea Carbonica, Ferrum Iodatum, Fumaricum Acidum, Kali Iodatum, Natrum Oxalaceticum, Pulsatilla (Vulgaris), Argentum Metallicum, Aurum Metallicum, Cuprum Metallicum, Eugenol, Formalinum, Lidocaine, Mercurius Solubilis, Molybdenum Metallicum, Niccolum Metallicum, | — Medicare Part D | — | — | — |
| CELECOXIB Celecoxib | — Medicare Part D | — | — | — |
| METOPROLOL TARTRATE AND HYDROCHLOROTHIAZIDE metoprolol tartrate and hydrochlorothiazide | — Medicare Part D | — | — | — |
| ARSENIC TRIOXIDE ARSENIC TRIOXIDE | — Medicare Part D | — | — | — |
| Smoflipid Smoflipid | — Medicare Part D | — | — | — |
| TEPYLUTE thiotepa | — Medicare Part D | — | — | — |
| Cetrorelix cetrorelix acetate | — Medicare Part D | — | — | — |
| XELPROS latanoprost | — Medicare Part D | — | — | — |
| Betoptic S betaxolol hydrochloride | — Medicare Part D | — | — | — |
| Gonal-f follitropin alfa | — Medicare Part D | — | — | — |
| Hyoscyamine Sulfate SL Hyoscyamine Sulfate | — Medicare Part D | — | — | — |
| Glimepiride Glimepiride | — Medicare Part D | — | — | — |
| Inflatherm Diclofenac Sodium and Menthol / Camphor Gel | — Medicare Part D | — | — | — |
| Carbamazepine ER Carbamazepine ER | — Medicare Part D | — | — | — |
| Donnatal phenobarbital, hyoscyamine sulfate, atropine sulfate, scopolamine hydrobromide | — Medicare Part D | — | — | — |
| METHYLPREDNISOLONE ACETATE Methylprednisolone acetate | — Medicare Part D | — | — | — |
| Mercaptopurine Mercaptopurine | — Medicare Part D | — | — | — |
| Dipyridamole DIPYRIDAMOLE | — Medicare Part D | — | — | — |
| Bepotastine Besilate Bepotastine Besilate | — Medicare Part D | — | — | — |
| KEVZARA sarilumab | — Medicare Part D | Yes | — | — |
| OSELTAMIVIR PHOSPHATE Oseltamivir phosphate | — Medicare Part D | — | — | — |
| Diflunisal Diflunisal | — Medicare Part D | — | — | — |
| Technetium Tc 99m Sestamibi Technetium TC 99m Sestamibi | — Medicare Part D | — | — | — |
| Hydroxychloroquine Hydroxychloroquine Sulfate | — Medicare Part D | — | — | — |
| Doxycycline Hyclate doxycycline hyclate | — Medicare Part D | — | — | — |
| Orladeyo Berotralstat hydrochloride | — Medicare Part D | — | — | — |
| Isolyte P in Dextrose Dextrose, Sodium Acetate, Potassium Chloride, Magnesium Chloride, and Potassium Phosphate, Dibasic | — Medicare Part D | — | — | — |
| Lansoprazole DR Lansoprazole | — Medicare Part D | — | — | — |
| PRUCALOPRIDE PRUCALOPRIDE | — Medicare Part D | — | — | — |
| Ruconest c1 esterase inhibitor recombinant | — Medicare Part D | Yes | — | — |
| LO LOESTRIN FE norethindrone acetate and ethinyl estradiol, ethinyl estradiol and ferrous fumarate | — Medicare Part D | — | — | — |
| Turalio pexidartinib hydrochloride | — Medicare Part D | — | — | — |
| ZINC SULFATE Zinc Sulfate Injection | — Medicare Part D | — | — | — |
| HYFTOR sirolimus | — Medicare Part D | — | — | — |
| Sitagliptin sitagliptin | — Medicare Part D | — | — | — |
| ULTRAMICROSIZE GRISEOFULVIN ULTRAMICROSIZE GRISEOFULVIN | — Medicare Part D | — | — | — |
| Quetiapine Extended Release Quetiapine | — Medicare Part D | — | — | — |
| Detrol tolterodine tartrate | — Medicare Part D | — | — | — |
| RALDESY TM TRAZODONE HYDROCHLORIDE ORAL | — Medicare Part D | — | — | — |