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 |
|---|---|---|---|---|
| Temsirolimus Temsirolimus Injection | — Medicare Part D | — | — | — |
| METAXALONE Metaxalone | — Medicare Part D | — | — | — |
| Raxibacumab raxibacumab | — Medicare Part D | — | — | — |
| Methocarb 500-EZS Methocarbamol | — Medicare Part D | — | — | — |
| Eligard Leuprolide Acetate | — Medicare Part D | — | — | — |
| CLOFARABINE Clofarabine | — Medicare Part D | — | — | — |
| Cymbalta Duloxetine hydrochloride | — Medicare Part D | — | — | — |
| Thyroid THYROID, UNSPECIFIED | — Medicare Part D | — | — | — |
| Menopur menotropins | — Medicare Part D | — | — | — |
| Sodium Iodide I-131 Sodium Iodide I-131 | — Medicare Part D | — | — | — |
| Doxycycline doxycycline | — Medicare Part D | — | — | — |
| CANCIDAS CASPOFUNGIN ACETATE | — Medicare Part D | — | — | — |
| Phenytoin Phenytoin Sodium | — Medicare Part D | — | — | — |
| EMSAM selegiline | — Medicare Part D | — | — | — |
| Nitrous Oxide Oxygen Mix Nitrous Oxide Oxygen Mix | — Medicare Part D | — | — | — |
| BUTALBITAL, ACETAMINOPHEN AND CAFFEINE butalbital, acetaminophen and caffeine | — Medicare Part D | — | — | — |
| Ellence epirubicin hydrochloride | — Medicare Part D | — | — | — |
| Xacduro sulbactam and durlobactam | — Medicare Part D | — | — | — |
| FINACEA FOAM azelaic acid | — Medicare Part D | — | — | — |
| RISEDRONATE SODIUM Risedronate Sodium | — Medicare Part D | — | — | — |
| Mesalamine Mesalamine | — Medicare Part D | — | — | — |
| GLUCAGON Glucagon | — Medicare Part D | Yes | — | — |
| ABRAXANE Paclitaxel | — Medicare Part D | — | — | — |
| zolmiptriptan zolmitriptan | — Medicare Part D | — | — | — |
| Scarzen DIMETHICONE | — Medicare Part D | — | — | — |
| THIAMINE HYDROCHLORIDE Thiamine Hydrochloride | — Medicare Part D | — | — | — |
| Phenylephrine Hydrochloride Phenylephrine Hydrochloride | — Medicare Part D | — | — | — |
| Premasol - sulfite-free (Amino Acid) LEUCINE, LYSINE, ISOLEUCINE, VALINE, HISTIDINE, PHENYLALANINE, THREONINE, METHIONINE, TRYPTOPHAN, TYROSINE, N-ACETYL-TYROSINE, ARGININE, PROLINE, ALANINE, GLUTAMIC ACIDE, SERINE, GLYCINE, ASPARTIC ACID, TAURINE, CYSTEINE HYDROCHLORIDE | — Medicare Part D | Yes | — | — |
| VUITY Pilocarpine Hydrochloride | — Medicare Part D | — | — | — |
| Quinapril and Hydrochlorothiazide Quinapril and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| VIVJOA oteseconazole | — Medicare Part D | — | — | — |
| RETROVIR zidovudine | — Medicare Part D | — | — | — |
| Morphine Sulfate MORPHINE SULFATE | — Medicare Part D | — | — | — |
| Optison Perflutren Protein-Type A Microspheres Human Albumin Microspheres and Perflutren | — Medicare Part D | — | — | — |
| STEGLUJAN ertugliflozin and sitagliptin | — Medicare Part D | — | — | — |
| LAZCLUZE lazertinib | — Medicare Part D | — | — | — |
| XYLOCAIN (LIDOCAINE HCl ) XYLOCAINE (LIDOCAINE HCl ) | — Medicare Part D | — | — | — |
| Pomalidomide Pomalidomide | — Medicare Part D | — | — | — |
| Temozolomide Temozolomide | — Medicare Part D | — | — | — |
| NIFEDIPINE Nifedipine | — Medicare Part D | — | — | — |
| Nora BE Norethindrone | — Medicare Part D | — | — | — |
| Dialyvite Ascorbic Acid, Thiamine, Riboflavin, Niacinamide, Pyridoxine, Folic Acid, Cobalamin, Biotin, Pantothenic Acid | — Medicare Part D | — | — | — |
| Salsalate Salsalate | — Medicare Part D | — | — | — |
| Increlex Mecasermin | — Medicare Part D | Yes | — | — |
| Labetalol Hydrochloride, Labetalol HCl in Sodium Chloride, Labetalol HCl in Dextrose | — Medicare Part D | — | — | — |
| Morphine Sulfate MORPHINE SULFATE | — Medicare Part D | — | — | — |
| OXERVATE cenegermin-bkbj | — Medicare Part D | — | — | — |
| Ampicillin Ampicillin | — Medicare Part D | — | — | — |
| LEVOFLOXACIN Levofloxacin | — Medicare Part D | — | — | — |
| SYMPROIC naldemedine | — Medicare Part D | — | — | — |