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 |
|---|---|---|---|---|
| Odomzo sonidegib | — Medicare Part D | — | — | — |
| DIFLUPREDNATE Difluprednate | — Medicare Part D | — | — | — |
| Lioresal (baclofen) baclofen | — Medicare Part D | — | — | — |
| FOSAPREPITANT FOSAPREPITANT | — Medicare Part D | — | — | — |
| LEUCOVORIN CALCIUM Leucovorin Calcium | — Medicare Part D | — | — | — |
| NEXIUM Esomeprazole magnesium | — Medicare Part D | — | — | — |
| Isoproterenol Hydrochloride Isoproterenol Hydrochloride | — Medicare Part D | — | — | — |
| VALTREX valacyclovir hydrochloride | — Medicare Part D | — | — | — |
| Felbatol felbamate | — Medicare Part D | — | — | — |
| Climara Estradiol | — Medicare Part D | — | — | — |
| Marbeta L Kit Betamethasone Sodium Phosphate, Betamethasone Acetate, Lidocaine Hydrochloride, Bupivacaine Hydrochloride, Povidine Iodine, Isopropyl Alcohol | — Medicare Part D | — | — | — |
| Desonide Desonide | — Medicare Part D | — | — | — |
| Xelria Fe norethindrone and ethinyl estradiol and ferrous fumarate | — Medicare Part D | — | — | — |
| Phenazopyridine Hydrochloride PHENAZOPYRIDINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Escitalopram Oxalate Escitalopram Oxalate | — Medicare Part D | — | — | — |
| Minocycline Hydrochloride minocycline hydrochloride | — Medicare Part D | — | — | — |
| NEVANAC nepafenac | — Medicare Part D | Yes | — | — |
| LIDOCAINE HCI AND EPINEPHRINE WITH EPINEPHRINE LIDOCAINE HCI AND EPINEPHRINE WITH EPINEPHRINE | — Medicare Part D | — | — | — |
| PRECEDEX DEXMEDETOMIDINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Lidocan III Lidocaine 5% | — Medicare Part D | — | — | — |
| Se-Natal 19 .beta.-carotene, ascorbic acid, cholecalciferol, .alpha.-tocopherol acetate, dl-, thiamine, riboflavin, niacinamide, pyridoxine hydrochloride, folic acid, cyanocobalamin, calcium pantothenate, calcium carbonate, ferrous fumarate, zinc oxide and docusate sodium | — Medicare Part D | — | — | — |
| Spiriva Respimat tiotropium bromide inhalation spray | — Medicare Part D | — | — | — |
| Eprontia Topiramate | — Medicare Part D | — | — | — |
| VOQUEZNA vonoprazan fumarate | — Medicare Part D | — | — | — |
| Betamethasone Sodium Phosphate and Betamethasone Acetate Betamethasone Sodium Phosphate and Betamethasone Acetate | — Medicare Part D | — | — | — |
| Bupivacaine BUPIVACAINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Hydrocodone Bitartrate Hydrocodone Bitartrate | — Medicare Part D | — | — | — |
| VELTASSA patiromer | — Medicare Part D | Yes | — | — |
| ELAHERE MIRVETUXIMAB SORAVTANSINE | — Medicare Part D | — | — | — |
| Strovite One Caplets Vitamin A, Calcium Pantothenate, Ascorbic Acid, Cholecalciferol, .Alpha.-Tocopherol Succinate, D-, Thiamine, Riboflavin, Niacinamide, Pyridoxine Hydrochloride, Folic Acid, Biotin, Cyanocobalamin, Selenium, Magnesium Oxide, Zinc Oxide, Cupric Sulfate, Manganese, Chromium, .Alpha.-Lipoic Acid, and Lutein | — Medicare Part D | — | — | — |
| Verapamil Hydrochloride verapamil hydrochloride | — Medicare Part D | — | — | — |
| Psorizide Ultra Potassium Bromide, Nickel Sulfate, and Zinc Bromide | — Medicare Part D | — | — | — |
| Denosumab-BMWO denosumab-bmwo | — Medicare Part D | Yes | — | — |
| TERUFLEX Blood Bag System with Diversion Blood Sampling Arm Anticoagulant CPD with OPTISOL Red Cell Preservative Solution for Collection of 500mL of Blood | — Medicare Part D | — | — | — |
| DONEPEZIL HYDROCHLORIDE Donepezil Hydrochloride | — Medicare Part D | — | — | — |
| Fluoxetine Fluoxetine Hydrochloride | — Medicare Part D | — | — | — |
| Timolol Maleate Timolol Maleate Ophthalmic | — Medicare Part D | — | — | — |
| Toronova SUIK Ketorolac Tromethamine | — Medicare Part D | — | — | — |
| OVACE SULFACETAMIDE SODIUM | — Medicare Part D | — | — | — |
| Aflora Multivitamin | — Medicare Part D | — | — | — |
| Ascomp with Codeine Butalbital, Aspirin, Caffeine and Codeine Phosphate | — Medicare Part D | — | — | — |
| Oxygen 64889-0001 Oxygen | — Medicare Part D | — | — | — |
| CARMUSTINE Carmustine | — Medicare Part D | — | — | — |
| Idacio adalimumab-aacf | — Medicare Part D | Yes | — | — |
| Clopidogrel Bisulfate clopidogrel bisulfate | — Medicare Part D | — | — | — |
| Apraclonidine Apraclonidine | — Medicare Part D | — | — | — |
| CNJ-016 Vaccinia Immune Globulin Intravenous (Human) | — Medicare Part D | — | — | — |
| ACETIC ACID Acetic Acid | — Medicare Part D | — | — | — |
| Dorzolamide Hydrochloride Ophthalmic Dorzolamide Hydrochloride | — Medicare Part D | — | — | — |
| Lidothol ES menthol 5%, lidocaine 4% | — Medicare Part D | — | — | — |