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 |
|---|---|---|---|---|
| Balsalazide Disodium Balsalazide Disodium | — Medicare Part D | — | — | — |
| Fondaparinux Sodium Fondaparinux Sodium | — Medicare Part D | — | — | — |
| Desvenlafaxine Desvenlafaxine | — Medicare Part D | — | — | — |
| Sucralfate Sucralfate | — Medicare Part D | — | — | — |
| FLUOROURACIL FLUOROURACIL | — Medicare Part D | — | — | — |
| Hemgenix etranacogene dezaparvovec | — Medicare Part D | — | — | — |
| PCXX ANTICARIES NO FLAVOR NE G Sodium Fluoride | — Medicare Part D | — | — | — |
| FLUVASTATIN SODIUM ER fluvastatin sodium | — Medicare Part D | — | — | — |
| ARSENIC TRIOXIDE ARSENIC TRIOXIDE | — Medicare Part D | — | — | — |
| Arformoterol Tartrate Arformoterol Tartrate | — Medicare Part D | — | — | — |
| Banophen diphenhydramine hcl | — Medicare Part D | — | — | — |
| Larin 1.5/30 Norethindrone Acetate/Ethinyl Estradiol | — Medicare Part D | — | — | — |
| MS Contin morphine sulfate | — Medicare Part D | — | — | — |
| Lithium Lithium Fluoratum | — Medicare Part D | — | — | — |
| Nexesta Fe norethindrone and ethinyl estradiol and ferrous fumarate | — Medicare Part D | — | — | — |
| Syprine trientine hydrochloride | — Medicare Part D | — | — | — |
| Humira Adalimumab | — Medicare Part D | Yes | — | — |
| UDSxMP Medicated System Furosemide, Benzalkonium Chloride | — Medicare Part D | — | — | — |
| Varenicline VARENICLINE | — Medicare Part D | — | — | — |
| Yasmin drospirenone and ethinyl estradiol | — Medicare Part D | — | — | — |
| QUININE SULFATE QUININE SULFATE | — Medicare Part D | — | — | — |
| Revuforj revumenib | — Medicare Part D | — | — | — |
| Actonel Risedronate Sodium | — Medicare Part D | — | — | — |
| Flurazepam Hydrochloride Flurazepam Hydrochloride | — Medicare Part D | — | — | — |
| FluoriMax 5000 Sensitive 1.1% Sodium Fluoride with 5% Potassium Nitrate Toothpaste | — Medicare Part D | — | — | — |
| QUIOFIC folic acid | — Medicare Part D | — | — | — |
| Dicyclomine Dicyclomine Hydrochloride | — Medicare Part D | — | — | — |
| CASGEVY exagamglogene autotemcel | — Medicare Part D | — | — | — |
| Alprazolam ODT C-IV Alprazolam ODT C-IV | — Medicare Part D | — | — | — |
| Bupivilog Kit marcaine, kenalog, povidone iodine | — Medicare Part D | — | — | — |
| METOPROLOL SUCCINATE Metoprolol succinate | — Medicare Part D | — | — | — |
| Fluphenazine Hydrochoride fluphenazine hydrochloride | — Medicare Part D | — | — | — |
| Sodium Phosphates sodium phosphate, monobasic, monohydrate and sodium phosphate, dibasic, anhydrous | — Medicare Part D | — | — | — |
| LEVETIRACETAM Levetiracetam | — Medicare Part D | — | — | — |
| Solosec secnidazole | — Medicare Part D | — | — | — |
| SODIUM POLYSTYRENE SULFONATE sodium polystyrene sulfonate | — Medicare Part D | — | — | — |
| TAKHZYRO lanadelumab-flyo | — Medicare Part D | Yes | — | — |
| METHYLPREDNISOLONE methylprednisolone sodium succinate | — Medicare Part D | — | — | — |
| Etravirine etravirine | — Medicare Part D | — | — | — |
| Methocarbamol Tablets, USP, 500 mg, Methocarbamol Tablets, USP, 750 mg | — Medicare Part D | — | — | — |
| BETIMOL timolol | — Medicare Part D | — | — | — |
| Clindagel CLINDAMYCIN | — Medicare Part D | — | — | — |
| Besponsa inotuzumab ozogamicin | — Medicare Part D | — | — | — |
| Pepcid famotidine | — Medicare Part D | — | — | — |
| Omnipaque Iohexol | — Medicare Part D | — | — | — |
| Atenolol Atenolol | — Medicare Part D | — | — | — |
| Oxycodone HCl Oxycodone HCl | — Medicare Part D | — | — | — |
| Salagen Pilocarpine Hydrochloride | — Medicare Part D | — | — | — |
| Cortisporin TC colistin sulfate, neomycin sulfate, thonzonium bromide and hydrocortisone acetate | — Medicare Part D | — | — | — |
| VEMLIDY Vemlidy | — Medicare Part D | — | — | — |