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 |
|---|---|---|---|---|
| IBUPROFEN AND FAMOTIDINE Ibuprofen and famotidine | — Medicare Part D | — | — | — |
| Humulin R U-500, Humulin R U-500 KwikPen | — Medicare Part D | — | — | — |
| LiquiCal Plus Multivitamin | — Medicare Part D | — | — | — |
| LAMIVUDINE lamivudine | — Medicare Part D | — | — | — |
| Tygacil TIGECYCLINE | — Medicare Part D | — | — | — |
| Qutenza capsaicin | — Medicare Part D | — | — | — |
| CARMUSTINE Carmustine | — Medicare Part D | — | — | — |
| Dyural 40 Kit Methylprednisolone Acetate, Lidocaine Hydrochloride, Bupivacaine Hydrochloride, Povidine Iodine, Sodium Chloride, Isopropyl Alcohol | — Medicare Part D | — | — | — |
| Guanfacine guanfacine | — Medicare Part D | — | — | — |
| Phenylephrine Hydrochloride, IMMPHENTIV | — Medicare Part D | — | — | — |
| CARBOPROST TROMETHAMINE Carboprost Tromethamine | — Medicare Part D | — | — | — |
| Lamotrigine ER Lamotrigine ER | — Medicare Part D | — | — | — |
| Stalevo | — Medicare Part D | — | — | — |
| Abiraterone Acetate Abiraterone Acetate | — Medicare Part D | — | — | — |
| Rhopressa netarsudil | — Medicare Part D | — | — | — |
| LEFLUNOMIDE Leflunomide | — Medicare Part D | — | — | — |
| cyproheptadine hydrochloride solution Cyproheptadine Hydrochloride | — Medicare Part D | — | — | — |
| NYLIA 7/7/7 Norethindrone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| KETOROLAC TROMETHAMINE Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| Latanoprostene Bunod Ophthalmic Solution, 0.024% | — Medicare Part D | — | — | — |
| Sofosbuvir and Velpatasvir Velpatasvir and Sofosbuvir | — Medicare Part D | — | — | — |
| INJURY HP Arnica Montana, Echinacea Angustifolia, Hypericum Perforatum, Phosphorus, Rancid Beef, Silicon Dioxide, Delphinium Staphisagria Seed, Comfrey Root | — Medicare Part D | — | — | — |
| ASPIRIN AND EXTENDED-RELEASE DIPYRIDAMOLE Aspirin and Extended-Release Dipyridamole | — Medicare Part D | — | — | — |
| Nizatidine Nizatidine | — Medicare Part D | — | — | — |
| Chateal EQ Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Etodolac Etodolac | — Medicare Part D | — | — | — |
| CHLOROTHIAZIDE SODIUM CHLOROTHIAZIDE SODIUM | — Medicare Part D | — | — | — |
| Ropivacaine Hydrochloride Ropivacaine Hydrochloride | — Medicare Part D | — | — | — |
| Cadira Compliant Blood Stat Lidocaine / Prilocaine | — Medicare Part D | — | — | — |
| METHYLPREDNISOLONE methylprednisolone sodium succinate | — Medicare Part D | — | — | — |
| Rinvoq Upadacitinib | — Medicare Part D | — | — | — |
| Zyclara imiquimod | — Medicare Part D | — | — | — |
| Theophylline (Anhydrous) Theophylline | — Medicare Part D | — | — | — |
| APRISO mesalamine | — Medicare Part D | — | — | — |
| UPNEEQ Oxymetazoline hydrochloride ophthalmic | — Medicare Part D | — | — | — |
| ARBLI losartan potassium | — Medicare Part D | — | — | — |
| POLOCAINE(R) -MPF (MEPIVACAINE HCI) MEPIVACAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| SILVER SULFADIAZINE Silver Sulfadiazine | — Medicare Part D | — | — | — |
| Daptomycin daptomycin | — Medicare Part D | — | — | — |
| LASTACAFT alcaftadine | — Medicare Part D | — | — | — |
| TRI-LUMA fluocinolone acetonide, hydroquinone, and tretinoin | — Medicare Part D | — | — | — |
| Atovaquone Oral Suspension Atovaquone | — Medicare Part D | — | — | — |
| Tenofovir Disoproxil Fumarate TENOFOVIR DISOPROXIL FUMARATE | — Medicare Part D | — | — | — |
| Amlodipine Besylate and Benazepril Hydrochloride Amlodipine Besylate and Benazepril Hydrochloride | — Medicare Part D | — | — | — |
| PLERIXAFOR plerixafor | — Medicare Part D | — | — | — |
| FLUOXETINE HYDROCHLORIDE Fluoxetine Hydrochloride | — Medicare Part D | — | — | — |
| Chlorpromazine Chlorpromazine | — Medicare Part D | — | — | — |
| TRIAMVEX Triamcinolone Acetonide | — Medicare Part D | — | — | — |
| Bactrim, Bactrim DS | — Medicare Part D | — | — | — |
| FELODIPINE Felodipine | — Medicare Part D | — | — | — |