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 |
|---|---|---|---|---|
| Ziprasidone Hydrochloride Ziprasidone HCl | — Medicare Part D | — | — | — |
| PROMETHEGAN Promethazine Hydrochloride | — Medicare Part D | — | — | — |
| SERTRALINE HYDROCHLORIDE Sertraline Hydrochloride | — Medicare Part D | — | — | — |
| INQOVI CEDAZURIDINE and DECITABINE | — Medicare Part D | — | — | — |
| Tridacaine XL Lidocaine | — Medicare Part D | — | — | — |
| TAZAROTENE TAZAROTENE | — Medicare Part D | — | — | — |
| Trimethobenzamide Hydrochloride Trimethobenzamide Hydrochloride | — Medicare Part D | — | — | — |
| Tri-Lo-Mili Norgestimate and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Amygdalus persica PRUNUS PERSICA FLOWER | — Medicare Part D | — | — | — |
| Gadoterate Meglumine gadoterate meglumine | — Medicare Part D | — | — | — |
| Lapis albus ALFALFA, AMERICAN GINSENG, APIS MELLIFICA, ASPARAGUS OFFICINALIS, AVENA SATIVA, BARYTA IODATA, BERBERIS VULGARIS, BRYONIA, CARDUUS MARIANUS, CHAMOMILLA, CHELIDONIUM MAJUS, CONIUM MACULATUM, FERRUM IODATUM, LAPIS ALBUS, LYCOPODIUM CLAVATUM, NATRUM CARBONICUM, PASSIFLORA INCARNATA, SCROPHULARIA NODOSA, SOLIDAGO VIRGAUREA, TARAXACUM OFFICINALE, UVA URSI | — Medicare Part D | — | — | — |
| Komzifti ziftomenib | — Medicare Part D | — | — | — |
| Xadago safinamide mesylate | — Medicare Part D | — | — | — |
| CLINDAMYCIN AND BENZOYL PEROXIDE clindamycin and benzoyl peroxide | — Medicare Part D | — | — | — |
| Aspirin and Dipyridamole Aspirin and Dipyridamole | — Medicare Part D | — | — | — |
| PROCENTRA dextroamphetamine sulfate | — Medicare Part D | — | — | — |
| PRAVASTATIN SODIUM PRAVASTATIN SODIUM | — Medicare Part D | — | — | — |
| LIDOCAINE AND PRILOCAINE Lidocaine and Prilocaine | — Medicare Part D | — | — | — |
| CHLORZOXAZONE CHLORZOXAZONE | — Medicare Part D | — | — | — |
| DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE AND AMPHETAMINE SULFATE Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate | — Medicare Part D | — | — | — |
| VENLAFAXINE HYDROCHLORIDE VENLAFAXINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Sodium Ferric Gluconate Complex in Sucrose Sodium Ferric Gluconate Complex in Sucrose | — Medicare Part D | — | — | — |
| METFORMIN HYDROCHLORIDE ER Metformin hydrochloride | — Medicare Part D | — | — | — |
| LUMAKRAS sotorasib | — Medicare Part D | — | — | — |
| Lidocan IV Lidocaine 5% | — Medicare Part D | — | — | — |
| Oxygen Helium Mixture 30/70 Oxygen Helium Mixture 30/70 | — Medicare Part D | — | — | — |
| MEKTOVI BINIMETINIB | — Medicare Part D | — | — | — |
| ORPHENADRINE CITRATE Orphenadrine citrate | — Medicare Part D | — | — | — |
| Praxbind idarucizumab | — Medicare Part D | — | — | — |
| Mounjaro, Mounjaro KwikPen | — Medicare Part D | Yes | — | — |
| VARDENAFIL HYDROCHLORIDE VARDENAFIL HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Extended Phenytoin Sodium extended phenytoin sodium | — Medicare Part D | — | — | — |
| Arranon nelarabine | — Medicare Part D | — | — | — |
| REMIFENTANIL HYDROCHLORIDE Remifentanil Hydrochloride | — Medicare Part D | — | — | — |
| Spherusol Coccidioides immitis Spherule-Derived Skin Test Antigen | — Medicare Part D | — | — | — |
| Bumetanide Bumetanide | — Medicare Part D | — | — | — |
| Cefixime Cefixime | — Medicare Part D | — | — | — |
| Abilify Asimtufii Aripiprazole | — Medicare Part D | — | — | — |
| Junel Fe 1/20 norethindrone acetate and ethinyl estradiol, and ferrous fumarate | — Medicare Part D | — | — | — |
| Amyvid Florbetapir F 18 | — Medicare Part D | — | — | — |
| Adalimumab-adbm adalimumab-adbm | — Medicare Part D | — | — | — |
| Sodium Citrate Blood-Pack Units, (PL 146 Plastic) Anticoagulant Sodium Citrate Solution | — Medicare Part D | — | — | — |
| Ery-Ped Erythromycin Ethylsuccinate | — Medicare Part D | — | — | — |
| Entacapone entacapone | — Medicare Part D | — | — | — |
| Deflazacort Oral Suspension Deflazacort | — Medicare Part D | — | — | — |
| TPN Electrolytes SODIUM CHLORIDE, CALCIUM CHLORIDE, POTASSIUM CHLORIDE, MAGNESIUM CHLORIDE, and SODIUM ACETATE ANHYDROUS | — Medicare Part D | — | — | — |
| SINEMET carbidopa and levodopa | — Medicare Part D | — | — | — |
| BOMYNTRA Denosumab | — Medicare Part D | Yes | — | — |
| Asenapine Asenapine | — Medicare Part D | — | — | — |
| Ativan lorazepam | — Medicare Part D | — | — | — |