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 |
|---|---|---|---|---|
| Calcipotriene and Betamethasone Dipropionate Calcipotriene, Betamethasone Dipropionate | — Medicare Part D | — | — | — |
| Cyclobenzaprine Hydrochloride CYCLOBENZAPRINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Zinc Chloride Zinc Chloride | — Medicare Part D | — | — | — |
| Phospholine Iodide echothiophate iodide for ophthalmic solution | — Medicare Part D | — | — | — |
| Tegretol, Tegretol XR | — Medicare Part D | — | — | — |
| Methenamine Hippurate Methenamine hippurate | — Medicare Part D | — | — | — |
| Glimepiride 3 mg Glimepiride | — Medicare Part D | — | — | — |
| VIBATIV telavancin hydrochloride | — Medicare Part D | — | — | — |
| Ascor Ascorbic Acid | — Medicare Part D | — | — | — |
| Fosphenytoin Sodium Fosphenytoin Sodium | — Medicare Part D | — | — | — |
| DOXEPIN doxepin hydrochloride | — Medicare Part D | — | — | — |
| Lidocaine 5% Patch Lidocaine 5% | — Medicare Part D | — | — | — |
| ExEm Foam Air Polymer-Type A Intrauterine Foam | — Medicare Part D | — | — | — |
| 2% LIDOCAINE HCI 2% LIDOCAINE HCI | — Medicare Part D | — | — | — |
| MESNA MESNA | — Medicare Part D | — | — | — |
| Mekinist trametinib | — Medicare Part D | — | — | — |
| Amlodipine and Valsartan Amlodipine and valsartan | — Medicare Part D | — | — | — |
| methylphenidate hydrochloride CD methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| DIPHENOXYLATE HYDROCHLORIDE AND ATROPINE SULFATE diphenoxylate hydrochloride and atropine sulfate | — Medicare Part D | — | — | — |
| Oxygen OXYGEN | — Medicare Part D | — | — | — |
| GLYBURIDE Glyburide | — Medicare Part D | — | — | — |
| Obagi-C Rx system C-Therapy Night Skin Lightening with Vitamins C and E HYDROQUINONE | — Medicare Part D | — | — | — |
| Diltiazem Hydrochloride diltiazem hydrochloride | — Medicare Part D | — | — | — |
| Pantoprazole Sodium DR Pantoprazole Sodium | — Medicare Part D | — | — | — |
| BiDil Hydralazine hydrochloride and Isosorbide dinitrate | — Medicare Part D | — | — | — |
| Microgestin 1/20 Norethindrone Acetate/Ethinyl Estradiol | — Medicare Part D | — | — | — |
| PYLARIFY PIFLUFOLASTAT F-18 | — Medicare Part D | — | — | — |
| Pantoprazole Sodium PANTOPRAZOLE | — Medicare Part D | — | — | — |
| Davimet Multivitamin | — Medicare Part D | — | — | — |
| Prednisone prednisone | — Medicare Part D | — | — | — |
| Testone CIK Testosterone Cypionate, Alcohol | — Medicare Part D | — | — | — |
| Isoproterenol Hydrochloride Isoproterenol Hydrochloride | — Medicare Part D | — | — | — |
| WEZLANA ustekinumab-auub | — Medicare Part D | Yes | — | — |
| TAVNEOS avacopan | — Medicare Part D | — | — | — |
| Oxygen, Compressed Gas OXYGEN | — Medicare Part D | — | — | — |
| Lidocan Lidocaine 5% | — Medicare Part D | — | — | — |
| TERUFLEX Blood Anticoagulant Citrate Phosphate Dextrose Adenine (CPDA-1) for Collection of 450mL of Blood | — Medicare Part D | — | — | — |
| Dextrose And Sodium Chloride DEXTROSE MONOHYDRATE and SODIUM CHLORIDE | — Medicare Part D | — | — | — |
| OvacePlus Plus SULFACETAMIDE SODIUM | — Medicare Part D | — | — | — |
| Omegaven Fish oil | — Medicare Part D | — | — | — |
| Multiple Electrolytes pH 7.4 sodium chloride, sodium gluconate, sodium acetate, potassium chloride and magnesium chloride | — Medicare Part D | — | — | — |
| Cuvposa glycopyrrolate | — Medicare Part D | — | — | — |
| SOLU-CORTEF hydrocortisone sodium succinate | — Medicare Part D | — | — | — |
| cholestyramine powder for suspension cholestyramine powder for suspension | — Medicare Part D | — | — | — |
| SODIUM SULFATE, POTASSIUM SULFATE, MAGNESIUM SULFATE sodium sulfate, potassium sulfate, magnesium sulfate | — Medicare Part D | — | — | — |
| nitrofurantoin (macrocrystals) NITROFURANTOIN | — Medicare Part D | — | — | — |
| DASATINIB dasatinib | — Medicare Part D | — | — | — |
| Brimonidine Tartrate brimonidine tartrate | — Medicare Part D | — | — | — |
| Tiger Supply Inc APF Sodium Fluoride | — Medicare Part D | — | — | — |
| Prevacid, Prevacid SoluTab | — Medicare Part D | — | — | — |