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 |
|---|---|---|---|---|
| MIDODRINE HYDROCHLORIDE Midodrine Hydrochloride | — Medicare Part D | — | — | — |
| Joenja Leniolisib | — Medicare Part D | — | — | — |
| Scopolamine Trandermal System scolopamine transdermal system | — Medicare Part D | — | — | — |
| Tiopronin Tiopronin | — Medicare Part D | — | — | — |
| Juniperus virginiana Rumex Crispus, Xanthoxylum Fraxineum, Lymph Node (Suis), Scrophularia Nodosa, Baryta Carbonica, Baryta Muriatica, Belladonna, Calcarea Carbonica, Conium Maculatum, Helleborus Niger, Iodium, Kali Phosphoricum, Lachesis Mutus, Natrum Phosphoricum, Silicea, Juniperus Virginiana | — Medicare Part D | — | — | — |
| Fluocinolone Acetonide Topical fluocinolone acetonide | — Medicare Part D | — | — | — |
| Enspryng Satralizumab | — Medicare Part D | Yes | — | — |
| Umeclidinium and Vilanterol Ellipta umeclidinium bromide and vilanterol trifenatate | — Medicare Part D | — | — | — |
| INPEFA sotagliflozin | — Medicare Part D | — | — | — |
| Avar-e LS SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| CIMETIDINE Cimetidine | — Medicare Part D | — | — | — |
| Zonisamide Zonisamide | — Medicare Part D | — | — | — |
| HYDREA HYDROXYUREA | — Medicare Part D | — | — | — |
| VALGANCICLOVIR Valganciclovir | — Medicare Part D | — | — | — |
| Omidria phenylephrine and ketorolac | — Medicare Part D | — | — | — |
| Inspra eplerenone | — Medicare Part D | — | — | — |
| Diethylpropion Hydrochloride ER Diethylpropion Hydrochloride | — Medicare Part D | — | — | — |
| NITRO-TIME NITROGLYCERIN | — Medicare Part D | — | — | — |
| Sprintec Norgestimate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| PLUVICTO lutetium Lu 177 vipivotide tetraxetan | — Medicare Part D | — | — | — |
| Gilenya Fingolimod hcl | — Medicare Part D | — | — | — |
| Fluocinolone Acetonide fluocinolone acetonide | — Medicare Part D | — | — | — |
| Abirtega Abiraterone acetate | — Medicare Part D | — | — | — |
| MOTPOLY XR lacosamide | — Medicare Part D | — | — | — |
| LIRAGLUTIDE Liraglutide | — Medicare Part D | — | — | — |
| TYRUKO natalizumab-sztn | — Medicare Part D | — | — | — |
| ZAVZPRET zavegepant | — Medicare Part D | — | — | — |
| Valstar valrubicin | — Medicare Part D | — | — | — |
| AGGRASTAT TIROFIBAN | — Medicare Part D | — | — | — |
| Avalide irbesartan and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Buprenorphine Hydrochloride BUPRENORPHINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Trionex Calcipotriene Cream, 0.005% and Transparent Dressing | — Medicare Part D | — | — | — |
| Dialyvite 5000 Ascorbic Acid, Tocopheryl Acid Succinate, Thiamine, Riboflavin, Niacinamide, Pyridoxine, Folic Acid, Cobalamin, Biotin, Pantothenic Acid, Zinc, Selenium | — Medicare Part D | — | — | — |
| Doptelet Sprinkle, DOPTELET | — Medicare Part D | — | — | — |
| RANOLAZINE Ranolazine | — Medicare Part D | — | — | — |
| Nexviazyme avalglucosidase alfa-ngpt | — Medicare Part D | — | — | — |
| REMICADE INFLIXIMAB | — Medicare Part D | — | — | — |
| DUTASTERIDE Dutasteride | — Medicare Part D | — | — | — |
| FABHALTA iptacopan | — Medicare Part D | — | — | — |
| AZACITIDINE AZACITIDINE | — Medicare Part D | — | — | — |
| Reglan Metoclopramide Hydrochloride | — Medicare Part D | — | — | — |
| Kabiven Dextrose, Soybean oil, Electrolytes, Lysine, Phenylalanine, Leucine, Valine, Threonine, Methionine, Isoleucine, Tryptophan, Alanine, Arginine, Glycine, Proline, Histidine, Glutamic Acid, Serine, Aspartic Acid and Tyrosine | — Medicare Part D | — | — | — |
| Cefotaxime Cefotaxime | — Medicare Part D | — | — | — |
| NUMBRINO cocaine hydrochloride nasal | — Medicare Part D | — | — | — |
| OPDIVO nivolumab | — Medicare Part D | — | — | — |
| Clarithromycin Clarithromycin | — Medicare Part D | — | — | — |
| CONEXXENCE Denosumab | — Medicare Part D | Yes | — | — |
| Nortriptyline Hydrochloride Nortriptyline Hydrochloride | — Medicare Part D | — | — | — |
| iwilfin EFLORNITHINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Fondaparinux Sodium Fondaparinux Sodium | — Medicare Part D | — | — | — |