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 |
|---|---|---|---|---|
| Carbon Dioxide/Oxygen Mix Carbon Dioxide/Oxygen Mix | — Medicare Part D | — | — | — |
| R-Gene Arginine Hydrochloride | — Medicare Part D | — | — | — |
| DEFINITY RT perflutren | — Medicare Part D | — | — | — |
| LOQTORZI toripalimab-tpzi | — Medicare Part D | — | — | — |
| Pimecrolimus Pimecrolimus | — Medicare Part D | — | — | — |
| Pentoxifylline Pentoxifylline | — Medicare Part D | — | — | — |
| Heparin Sodium Heparin Sodium | — Medicare Part D | — | — | — |
| RYZNEUTA efbemalenograstim alfa-vuxw | — Medicare Part D | — | — | — |
| sfRowasa Sulfite-Free Formulation mesalamine | — Medicare Part D | — | — | — |
| Levetiracetam ER Levetiracetam | — Medicare Part D | — | — | — |
| Carbidopa Carbidopa and Levodopa | — Medicare Part D | — | — | — |
| Femring estradiol acetate | — Medicare Part D | — | — | — |
| HYDROMORPHONE HYDROCHLORIDE HYDROMORPHONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| SERTRALINE HYDROCHLORIDE Sertraline Hydrochloride | — Medicare Part D | — | — | — |
| Evista Raloxifene hydrochloride | — Medicare Part D | — | — | — |
| Tri-Lo- Estarylla norgestimate and ethinyl estradiol | — Medicare Part D | — | — | — |
| Oxygen Compressed UN 1072 Refrigerated UN 1073 OXYGEN | — Medicare Part D | — | — | — |
| DULOXETINE HYDROCHLORIDE DULOXETINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| AVODART dutasteride | — Medicare Part D | — | — | — |
| NU-DERM System NORMAL-Oily SKIN TRANSFORMATION HYDROQUINONE, HOMOSALATE, OCTISALATE, and ZINC OXIDE | — Medicare Part D | — | — | — |
| XELSTRYM DEXTROAMPHETAMINE | — Medicare Part D | — | — | — |
| RIZATRIPTAN BENZOATE Rizatriptan Benzoate | — Medicare Part D | — | — | — |
| Ferralet 90 iron, folic acid, cyanocobalamin, ascorbic acid, and docusate sodium | — Medicare Part D | — | — | — |
| FLUOXETINE HYDROCHLORIDE Fluoxetine Hydrochloride | — Medicare Part D | — | — | — |
| Aloprim Allopurinol | — Medicare Part D | — | — | — |
| CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE CLINDAMYCIN PHOSPHATE AND BENZOYL PEROXIDE | — Medicare Part D | — | — | — |
| NRG Hemo-Stat Aluminum Chloride | — Medicare Part D | — | — | — |
| EMROSI Minocycline Hydrochloride Extended-Release | — Medicare Part D | — | — | — |
| Fosamprenavir Calcium FOSAMPRENAVIR CALCIUM | — Medicare Part D | — | — | — |
| PureLife APF Sodium Fluoride | — Medicare Part D | — | — | — |
| TIS-U-SOL sodium chloride, potassium chloride, magnesium sulfate, sodium phosphate, and potassium phosphate | — Medicare Part D | — | — | — |
| Lotemax loteprednol etabonate | — Medicare Part D | — | — | — |
| Oxygen/Helium 50/50 Oxygen/Helium 50/50 | — Medicare Part D | — | — | — |
| Mycostatin Nystatin | — Medicare Part D | — | — | — |
| Estratest HS, Estratest FS | — Medicare Part D | — | — | — |
| Promethazine DM Promethazine Hydrochloride and Dextromethorphan Hydrobromide | — Medicare Part D | — | — | — |
| Temazepam temazepam | — Medicare Part D | — | — | — |
| BACTERIOSTATIC WATER Bacteriostatic Water | — Medicare Part D | — | — | — |
| Folaten Multivitamin | — Medicare Part D | — | — | — |
| RYANODEX dantrolene sodium dantrolene sodium | — Medicare Part D | — | — | — |
| OCTREOSCAN Indium In -111 Pentetreotide | — Medicare Part D | — | — | — |
| HYDROXYCHLOROQUINE SULFATE Hydroxychloroquine Sulfate | — Medicare Part D | — | — | — |
| Desvenlafaxine Desvenlafaxine | — Medicare Part D | — | — | — |
| Microgestin 1.5/30 Norethindrone Acetate/Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Nelarabine Nelarabine | — Medicare Part D | — | — | — |
| Gattex teduglutide | — Medicare Part D | Yes | — | — |
| DARIFENACIN Darifenacin Hydrobromide | — Medicare Part D | — | — | — |
| Ciclopirox Olamine Ciclopirox Olamine | — Medicare Part D | — | — | — |
| Cefaclor Cefaclor | — Medicare Part D | — | — | — |
| TREANDA Bendamustine Hydrochloride | — Medicare Part D | — | — | — |