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 |
|---|---|---|---|---|
| Lidocort LIDOCAINE HCL - HYDROCORTISONE ACETATE | — Medicare Part D | — | — | — |
| Ursodiol 200 mg, Ursodiol 400 mg | — Medicare Part D | — | — | — |
| Nitrofurantion Macrocrystals Nitrofurantion Macrocrystals | — Medicare Part D | — | — | — |
| Finasteride Finasteride | — Medicare Part D | — | — | — |
| SODIUM PHENYLACETATE AND SODIUM BENZOATE sodium phenylacetate and sodium benzoate | — Medicare Part D | — | — | — |
| Oxygen/Nitrogen 15/85 Oxygen/Nitrogen 15/85 | — Medicare Part D | — | — | — |
| Cetacaine Topical Anesthetic Benzocaine, Butamben, and Tetracaine Hydrochloride | — Medicare Part D | — | — | — |
| Trimethoprim Trimethoprim | — Medicare Part D | — | — | — |
| IFEX ifosfamide | — Medicare Part D | — | — | — |
| Adefovir dipivoxil ADEFOVIR DIPIVOXIL | — Medicare Part D | — | — | — |
| ALTAVERA Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| METROGEL metronidazole | — Medicare Part D | — | — | — |
| ONDANSETRON Ondansetron | — Medicare Part D | — | — | — |
| Dificid, DIFICID | — Medicare Part D | — | — | — |
| SYMPAZAN clobazam | — Medicare Part D | — | — | — |
| Denta 5000 Plus Sodium fluoride | — Medicare Part D | — | — | — |
| LAMPIT nifurtimox | — Medicare Part D | — | — | — |
| Natazia estradiol valerate and estradiol valerate/dienogest | — Medicare Part D | — | — | — |
| MYXREDLIN insulin human | — Medicare Part D | — | — | — |
| Fenovar Diclofenac Sodium and Menthol, Methyl salicylate | — Medicare Part D | — | — | — |
| VENXXIVA tiopronin | — Medicare Part D | — | — | — |
| NephroScan SUCCIMER | — Medicare Part D | — | — | — |
| EVEROLIMUS Everolimus | — Medicare Part D | — | — | — |
| LEVOXYL levothyroxine sodium | — Medicare Part D | — | — | — |
| Brinsupri Brensocatib | — Medicare Part D | — | — | — |
| Fluticasone Furoate Ellipta fluticasone furoate | — Medicare Part D | — | — | — |
| Cefoxitin Cefoxitin | — Medicare Part D | — | — | — |
| PROCTOFOAM HC pramoxine hydrochloride hydrocortisone acetate | — Medicare Part D | — | — | — |
| Polyethylene Glycol 3350, Sodium Chloride, Sodium Bicarbonate and Potassium Chloride - Unflavored, Polyethylene Glycol 3350, Sodium Chloride, Sodium Bicarbonate and Potassium Chloride with Lemon Flavor, Polyethylene Glycol 3350, Sodium Chloride, Sodium Bicarbonate and Potassium Chloride with Orange Flavor | — Medicare Part D | — | — | — |
| Nitrofurantion Nitrofurantion | — Medicare Part D | — | — | — |
| Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound) Paclitaxel | — Medicare Part D | — | — | — |
| Avar-e SULFACETAMIDE SODIUM, SULFUR | — Medicare Part D | — | — | — |
| PERMETHRIN PERMETHRIN | — Medicare Part D | — | — | — |
| PACLITAXEL PACLITAXEL paclitaxel | — Medicare Part D | — | — | — |
| PULMICORT RESPULES Budesonide | — Medicare Part D | — | — | — |
| Amitza Lubiprostone | — Medicare Part D | — | — | — |
| Exondys 51 eteplirsen | — Medicare Part D | — | — | — |
| EGRIFTA WR tesamorelin | — Medicare Part D | Yes | — | — |
| XYLOCAINE(R) -MPF (LIDOCAINE HCI AND EPINEPHRINE) XYLOCAINE-MPF WITH EPI | — Medicare Part D | — | — | — |
| Metformin ER 500 mg, Metformin ER 750 mg | — Medicare Part D | — | — | — |
| RIZATRIPTAN BENZOATE Rizatriptan Benzoate | — Medicare Part D | — | — | — |
| HYDRALAZINE HYDROCHLORIDE Hydralazine Hydrochloride | — Medicare Part D | — | — | — |
| PAPAVERINE HYDROCHLORIDE Papaverine Hydrochloride | — Medicare Part D | — | — | — |
| Dexmedetomidine Hydrochloride in Sodium Chloride Dexmedetomidine Hydrochloride in Sodium Chloride | — Medicare Part D | — | — | — |
| Hextend HETASTARCH | — Medicare Part D | — | — | — |
| EMBLAVEO aztreonam and avibactam | — Medicare Part D | — | — | — |
| ADDYI flibanserin | — Medicare Part D | — | — | — |
| Twirla levonorgestrel/ethinyl estradiol | — Medicare Part D | — | — | — |
| SIMPONI ARIA golimumab | — Medicare Part D | Yes | — | — |
| Corvert ibutilide fumarate | — Medicare Part D | — | — | — |