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 |
|---|---|---|---|---|
| Nexterone amiodarone hydrochloride | — Medicare Part D | — | — | — |
| Pramipexole Dihydrochloride Extended-Release Pramipexole Dihydrochloride | — Medicare Part D | — | — | — |
| Amitriptyline Hydrochloride Amitriptyline Hydrochloride | — Medicare Part D | — | — | — |
| NAGLAZYME galsulfase | — Medicare Part D | — | — | — |
| Buprenorphine Sublingual Buprenorphine Sublingual | — Medicare Part D | — | — | — |
| Normosol-R SODIUM CHLORIDE, SODIUM ACETATE ANHYDROUS, SODIUM GLUCONATE, POTASSIUM CHLORIDE, AND MAGNESIUM CHLORIDE | — Medicare Part D | — | — | — |
| Lycopus virginicus 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 | — | — | — |
| KOMBIGLYZE XR SAXAGLIPTIN AND METFORMIN HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Lovaza OMEGA-3-ACID ETHYL ESTERS | — Medicare Part D | — | — | — |
| Tencon butalbital and acetaminophen | — Medicare Part D | — | — | — |
| Ibuprofen Famotidine Ibuprofen Famotidine | — Medicare Part D | — | — | — |
| BUPRENORPHINE HYDROCHLORIDE and NALOXONE HYDROCHLORIDE DIHYDRATE BUPRENORPHINE HYDROCHLORIDE and NALOXONE HYDROCHLORIDE DIHYDRATE | — Medicare Part D | — | — | — |
| RAMELTEON Ramelteon | — Medicare Part D | — | — | — |
| INDOMETHACIN Indomethacin | — Medicare Part D | — | — | — |
| SAPROPTERIN DIHYDROCHLORIDE sapropterin dihydrochloride | — Medicare Part D | — | — | — |
| Desonide Ointment, 0.05% Desonide Ointment, 0.05% | — Medicare Part D | — | — | — |
| Enalapril Maleate and Hydrochlorothiazide Enalapril maleate and hydrochlorothiazide | — Medicare Part D | — | — | — |
| PHENYLEPHRINE HCI PHENYLEPHRINE HCI | — Medicare Part D | — | — | — |
| ERGOCALCIFEROL ergocalciferol | — Medicare Part D | — | — | — |
| Norvir Ritonavir | — Medicare Part D | — | — | — |
| Onfi clobazam | — Medicare Part D | — | — | — |
| Para Solve Calc carb, Chenopodium anth, Cina, Croton, Filix Mas, Gambocia, Granatum, Lycopodium, Merc corros, Nat phos, Santoninum, Senna, Spigelia anth, Stannum met, Tanacetum, Teuricum mar, Zingiber | — Medicare Part D | — | — | — |
| REMERONSOLTAB, REMERON | — Medicare Part D | — | — | — |
| Dopram Doxapram hydrochloride | — Medicare Part D | — | — | — |
| METFORMIN HYDROCHLORIDE metformin hydrochloride | — Medicare Part D | — | — | — |
| Carbamazepine Carbamazepine | — Medicare Part D | — | — | — |
| POTASSIUM CHLORIDE EXTENDED RELEASE Potassium chloride | — Medicare Part D | — | — | — |
| RISEDRONATE SODIUM Risedronate Sodium | — Medicare Part D | — | — | — |
| ETOMIDATE Etomidate | — Medicare Part D | — | — | — |
| Lidocaine HCl 3% and Hydrocortisone Acetate 0.5% Cream Lidocaine HCl and Hydrocortisone Acetate | — Medicare Part D | — | — | — |
| NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE NITROFURANTOIN MONOHYDRATE | — Medicare Part D | — | — | — |
| PHYTONADIONE Phytonadione | — Medicare Part D | — | — | — |
| Duloxetine DR Duloxetine | — Medicare Part D | — | — | — |
| DEXTROSE MONOHYDRATE dextrose monohydrate | — Medicare Part D | — | — | — |
| Sodium Sulfacetamide 10% and Sulfur 5% Cleanser Sodium Sulfacetamide 10% and Sulfur 5% | — Medicare Part D | — | — | — |
| DIMETHYL FUMARATE Dimethyl fumarate | — Medicare Part D | — | — | — |
| ELEPSIA XR 1000 MG, ELEPSIA XR 1500 MG | — Medicare Part D | — | — | — |
| POTELIGEO mogamulizumab-kpkc | — Medicare Part D | — | — | — |
| TRIPTODUR triptorelin | — Medicare Part D | — | — | — |
| ACETAZOLAMIDE EXTENDED-RELEASE Acetazolamide Extended-Release | — Medicare Part D | — | — | — |
| Amitriptyline HCL Amitriptyline Hcl | — Medicare Part D | — | — | — |
| DEHYDRATED ALCOHOL ALCOHOL | — Medicare Part D | — | — | — |
| Ziprasidone Mesylate ZIPRASIDONE MESYLATE | — Medicare Part D | — | — | — |
| Revonto dantrolene sodium | — Medicare Part D | — | — | — |
| GLYBURIDE Glyburide | — Medicare Part D | — | — | — |
| BOSAYA Denosumab-kyqq | — Medicare Part D | — | — | — |
| Metformin HCL Metformin HCl | — Medicare Part D | — | — | — |
| Pituitarum posterium ARGENTUM NITRICUM, ATROPINUM SULPHURICUM, AURUM MURIATICUM NATRONATUM, BOS TAURUS OVARY, BOS TAURUS PANCREAS, BOS TAURUS PITUITARUM POSTERIUM, BOS TAURUS UTERUS, CIMICIFUGA RACEMOSA, ESTRONE, HELONIAS DIOICA, PROGESTERONE, PULSATILLA VULGARIS, SABINA, SEPIA, SEQUOIADENDRON GIGANTEUM WHOLE, SUS SCROFA PINEAL GLAND, SUS SCROFA SPLEEN, THIOSINAMINUM, THYROIDINUM, VIBURNUM OPULUS | — Medicare Part D | — | — | — |
| NIKTIMVO axatilimab-csfr | — Medicare Part D | — | — | — |
| Magnesium Sulfate MAGNESIUM SULFATE HEPTAHYDRATE | — Medicare Part D | — | — | — |