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 |
|---|---|---|---|---|
| Inluriyo imlunestrant | — Medicare Part D | — | — | — |
| JUBBONTI denosumab | — Medicare Part D | Yes | — | — |
| AMLODIPINE AND OLMESARTAN MEDOXOMIL Amlodipine and Olmesartan Medoxomil | — Medicare Part D | — | — | — |
| Pantoprazole Sodium PANTOPRAZOLE | — Medicare Part D | — | — | — |
| linagliptin LINAGLIPTIN | — Medicare Part D | — | — | — |
| Pramipexole Dihydrochloride Pramipexole Dihydrochloride | — Medicare Part D | — | — | — |
| TOSYMRA Sumatriptan | — Medicare Part D | — | — | — |
| Sevelamer Carbonate SEVELAMER CARBONATE | — Medicare Part D | — | — | — |
| FIRVANQ vancomycin hydrochloride | — Medicare Part D | — | — | — |
| SALICYLIC ACID Salicylic Acid | — Medicare Part D | — | — | — |
| Methylprednisolone Sodium Succinate methylprednisolone sodium succinate | — Medicare Part D | — | — | — |
| CLEMASTINE FUMARATE Clemastine Fumarate | — Medicare Part D | — | — | — |
| Daptomycin in Sodium Chloride Daptomycin in Sodium Chloride | — Medicare Part D | — | — | — |
| BROMSITE 0.075% bromfenac | — Medicare Part D | — | — | — |
| Fluvoxamine Maleate Fluvoxamine Maleate | — Medicare Part D | — | — | — |
| Midazolam Midazolam | — Medicare Part D | — | — | — |
| Carbamazepine, Carbamazepin | — Medicare Part D | — | — | — |
| memantine hydrochloride and donepezil hydrochloride memantine hydrochloride and donepezil hydrochloride | — Medicare Part D | — | — | — |
| METAXALONE Metaxalone | — Medicare Part D | — | — | — |
| Urea Cream 40 Percent Urea | — Medicare Part D | — | — | — |
| LETROZOLE Letrozole | — Medicare Part D | — | — | — |
| NEOPROFEN ibuprofen lysine | — Medicare Part D | — | — | — |
| drospirenone, ethinyl estradiol and levomefolate calcium and levomefolate calcium drospirenone, ethinyl estradiol and levomefolate calcium and levomefolate calcium | — Medicare Part D | — | — | — |
| AKTEN LIDOCAINE HYDROCHLORIDE ANHYDROUS | — Medicare Part D | — | — | — |
| Sodium Fluoride and Potassium Nitrate Sodium Fluoride and Potassium Nitrate | — Medicare Part D | — | — | — |
| RYTARY Carbidopa and Levodopa | — Medicare Part D | — | — | — |
| Oxygen-Helium Mixture Oxygen-Helium Mixture | — Medicare Part D | — | — | — |
| Gvoke VialDx glucagon injection | — Medicare Part D | Yes | — | — |
| IMAVY | — Medicare Part D | — | — | — |
| Pyrimethamine pyrimethamine | — Medicare Part D | — | — | — |
| ROPINIROLE ROPINIROLE | — Medicare Part D | — | — | — |
| OXAZEPAM Oxazepam | — Medicare Part D | — | — | — |
| Alosetron Hydrochloride Alosetron Hydrochloride | — Medicare Part D | — | — | — |
| Divalproex Sodium ER Divalproex Sodium ER | — Medicare Part D | — | — | — |
| Chlorhexidine Gluconate, 0.12% Oral Rinse | — Medicare Part D | — | — | — |
| ATENOLOL AND CHLORTHALIDONE Atenolol and Chlorthalidone | — Medicare Part D | — | — | — |
| LUTRATE DEPOT leuprolide acetate | — Medicare Part D | — | — | — |
| Dilantin-125 Phenytoin | — Medicare Part D | — | — | — |
| PARSABIV etelcalcetide | — Medicare Part D | — | — | — |
| Flyrcado FLURPIRIDAZ F-18 | — Medicare Part D | — | — | — |
| Cerdelga eliglustat | — Medicare Part D | — | — | — |
| Cardioplegic Calcium Chloride, Magnesium Chloride, Potassium Chloride and Sodium Chloride | — Medicare Part D | — | — | — |
| IXEMPRA ixabepilone | — Medicare Part D | — | — | — |
| Metoprolol Succinate ER Metoprolol Succinate ER Tablets | — Medicare Part D | — | — | — |
| QNASL Beclomethasone Dipropionate | — Medicare Part D | — | — | — |
| Nitisinone Nitisinone | — Medicare Part D | — | — | — |
| TRYNGOLZA olezarsen sodium | — Medicare Part D | Yes | — | — |
| clopidogrel, Clopidogrel | — Medicare Part D | — | — | — |
| Albuterol Sulfate Inhalation Solution, 0.5% | — Medicare Part D | — | — | — |
| ANIMAL ANTIGEN FelisCatusHair,BosTaurusHair,BosTaurusSkin,GallusGallusFeather,CanisLupusFamiliarisSkin,CanisFamiliarisHair,AnasPlatyrhynchosFeather,AnserAnserFeather,CaviaPorcellusHair,CaviaPorcellusSkin,MesocricetusAuratusHair,MesocricetusAuratusSkin,SusScrofaHair,SusScrofaSkin,EquusCaballusHair,EquusCaballusDander,MusMusculusHair,MusMusculuasSkin,OryctolagusCuniculusSkin,OryctolagusCuniculusHair,OvisAriesWhole,MeleagrisGallopavoFeather,ArsenicTrioxide,BlattaOrientalis,StrychnosNux-VomicaSeed,Phosphorus,Pulsatilla,Sulfur | — Medicare Part D | — | Step therapy | — |