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 |
|---|---|---|---|---|
| Hydroxyzine Hydroxyzine hydrochloride | — Medicare Part D | — | — | — |
| Deferoxamine DEFEROXAMINE MESYLATE | — Medicare Part D | — | — | — |
| BELBUCA buprenorphine hydrochloride | — Medicare Part D | — | — | — |
| OLMESARTAN MEDOXOMIL, AMLODIPINE and HYDROCHLOROTHIAZIDE Olmesartan medoxomil, amlodipine and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Proparacaine Hydrochloride Proparacaine Hydrochloride | — Medicare Part D | — | — | — |
| iopamidol iopamidol | — Medicare Part D | — | — | — |
| ZIIHERA zanidatamab-hrii | — Medicare Part D | — | — | — |
| Terbinafine Terbinafine Hydrochloride | — Medicare Part D | — | — | — |
| YERVOY ipilimumab | — Medicare Part D | — | — | — |
| TIZANIDINE HYDROCHLORIDE tizanidine hydrochloride | — Medicare Part D | — | — | — |
| HUMALOG, Humalog KwikPen | — Medicare Part D | — | — | — |
| Kit for the Preparation of Technetium Tc99m Pyrophosphate technetium tc99m pyrophosphate | — Medicare Part D | — | — | — |
| P- PACK PREDNISONE 20MG, 7- DAY TAPERING DOSE PACK | — Medicare Part D | — | — | — |
| CERETEC TECHNETIUM TC-99M EXAMETAZIME | — Medicare Part D | — | — | — |
| LATISSE bimatoprost | — Medicare Part D | — | — | — |
| TEMODAR Temozolomide | — Medicare Part D | — | — | — |
| Isoniazid Isoniazid | — Medicare Part D | — | — | — |
| CRESEMBA isavuconazonium sulfate | — Medicare Part D | — | — | — |
| Pemetrexed PEMETREXED DISODIUM | — Medicare Part D | — | — | — |
| Lotensin HCT benazepril hydrochloride and hydrochlorothiazide | — Medicare Part D | — | — | — |
| ACUVAIL ketorolac tromethamine | — Medicare Part D | — | — | — |
| Neomycin and Polymyxin B Sulfates and Hydrocortisone Otic Suspension neomycin and polymyxin B sulfates and hydrocortisone otic | — Medicare Part D | — | — | — |
| PRAVASTATIN SODIUM PRAVASTATIN SODIUM | — Medicare Part D | — | — | — |
| DUTASTERIDE Dutasteride | — Medicare Part D | — | — | — |
| NARCAN naloxone hydrochloride nasal | — Medicare Part D | — | — | — |
| PREDNISOLONE ACETATE prednisolone acetate | — Medicare Part D | — | — | — |
| GALBRIELA norethindrone and ethinyl estradiol and ferrous fumarate | — Medicare Part D | — | — | — |
| KETOCONAZOLE Ketoconazole | — Medicare Part D | — | — | — |
| Cyklokapron tranexamic acid | — Medicare Part D | — | — | — |
| Indium DTPA In 111 Indium In-111 Pentetate Disodium | — Medicare Part D | — | — | — |
| Firazyr icatibant acetate | — Medicare Part D | — | — | — |
| Dsuvia Sufentanil | — Medicare Part D | — | — | — |
| HYRIMOZ adalimumab-adaz | — Medicare Part D | — | — | — |
| Daurismo glasdegib | — Medicare Part D | — | — | — |
| VIMIZIM elosulfase alfa | — Medicare Part D | — | — | — |
| Glyxambi empagliflozin and linagliptin | — Medicare Part D | — | — | — |
| ZORYVE roflumilast | — Medicare Part D | — | — | — |
| VENLAFAXINE venlafaxine hydrochloride | — Medicare Part D | — | — | — |
| Methylphenidate Hydrochloride (LA) methylphenidate hydrochloride | — Medicare Part D | — | — | — |
| DermacinRx ZRM Pak lidocaine, dimethicone | — Medicare Part D | — | — | — |
| Kimyrsa oritavancin diphosphate | — Medicare Part D | — | — | — |
| EMPLICITI elotuzumab | — Medicare Part D | — | — | — |
| EPIDUO adapalene and benzoyl peroxide | — Medicare Part D | — | — | — |
| Frindovyx Cyclophosphamide | — Medicare Part D | — | — | — |
| Meropenem Meropenem | — Medicare Part D | — | — | — |
| Fosphenytoin Sodium Fosphenytoin Sodium | — Medicare Part D | — | — | — |
| Pioglitazole and metformin hydrochloride Pioglitazole and metformin hydrochloride | — Medicare Part D | — | — | — |
| JUNEL FE 28 DAY Norethindrone Acetate and Ethinyl Estradiol and Ferrous Fumarate | — Medicare Part D | — | — | — |
| BUTALBITAL, ASPIRIN, AND CAFFEINE Butalbital, aspirin, and caffeine | — Medicare Part D | — | — | — |
| Doxazosin Mesylate Doxazosin Mesylate | — Medicare Part D | — | — | — |