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 |
|---|---|---|---|---|
| (CHLOROPROCAINE HCI (CHLOROPROCAINE HCI | — Medicare Part D | — | — | — |
| ISTODAX romidepsin | — Medicare Part D | — | — | — |
| Activase Alteplase | — Medicare Part D | — | — | — |
| BEOVU brolucizumab | — Medicare Part D | — | — | — |
| METHYLPREDNISOLONE methylprednisolone sodium succinate | — Medicare Part D | — | — | — |
| Adalimumab-bwwd adalimumab-bwwd | — Medicare Part D | — | — | — |
| Efavirenz, Emtricitabine And Tenofovir Disoproxil Fumarate Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate | — Medicare Part D | — | — | — |
| ADSOL RED CELL PRESERVATION Anticoagulant Citrate Phosphate Dextrose (CPD) Solution and ADSOL Preservation Solution | — Medicare Part D | — | Step therapy | — |
| Origanum marjorana ORIGANUM MAJORANA | — Medicare Part D | — | — | — |
| Glipizide and Metformin HCl Glipizide and Metformin HCl | — Medicare Part D | — | — | — |
| Respiratory Plus Arsenicum Iodatum, Blatta Orientalis, Cinnamic Acid, Coumarinum, Gallicum Acidum, House Dust Mite, Indolum, Malvin, Naphthalinum, Oxygenium, Pothos Foetidus, Quebracho, Quercetin, Ribes Nigrum, Rutin, Viburnum Opulus | — Medicare Part D | Yes | — | — |
| Bruselix Gel Vitamin C, Zinc, Arnica Montana Extract, Bromelain, Diosmin, Rutin, Citrus Bioflavonoids, Hesperidin Methyl Chalcone | — Medicare Part D | — | — | — |
| FIRMAGON Degarelix | — Medicare Part D | Yes | — | — |
| DESCOVY emtricitabine and tenofovir alafenamide | — Medicare Part D | — | — | — |
| Aubagio teriflunomide | — Medicare Part D | — | — | — |
| Calcitonin Salmon Calcitonin Salmon | — Medicare Part D | — | — | — |
| Methocarbamol Tablets, USP, 750 mg | — Medicare Part D | — | — | — |
| Levothyroxine Sodium Levothyroxine Sodium | — Medicare Part D | — | — | — |
| SOTYKTU deucravacitinib | — Medicare Part D | — | — | — |
| ISOVUE-M IOPAMIDOL | — Medicare Part D | — | — | — |
| Zilretta triamcinolone acetonide extended-release injectable suspension | — Medicare Part D | — | — | — |
| DORYX MPC doxycycline hyclate | — Medicare Part D | — | — | — |
| BUPRENORPHINE Buprenorphine | — Medicare Part D | — | — | — |
| Zolgensma onasemnogene abeparvovec-xioi | — Medicare Part D | — | — | — |
| Esomeprazole Magnesium esomeprazole magnesium | — Medicare Part D | — | — | — |
| Signifor pasireotide | — Medicare Part D | Yes | — | — |
| ACETADOTE Acetylcysteine | — Medicare Part D | — | — | — |
| ELIMITE permethrin | — Medicare Part D | — | — | — |
| Emerphed Ephedrine Sulfate | — Medicare Part D | — | — | — |
| DRAXIMAGE DTPA Kit for the preparation of Technetium Tc 99m Pentetate | — Medicare Part D | — | — | — |
| FARXIGA DAPAGLIFLOZIN | — Medicare Part D | — | — | — |
| Tamsulosin Hydrochloride Tamsulosin Hydrochloride | — Medicare Part D | — | — | — |
| Theophylline Anhydrous Theophylline Anhydrous | — Medicare Part D | — | — | — |
| Norpace CR, Norpace | — Medicare Part D | — | — | — |
| Adapalene ADAPALENE | — Medicare Part D | — | — | — |
| Acyclovir acyclovir | — Medicare Part D | — | — | — |
| Back and Leg HP Aconitum Napellus, Aesculus Hippocastanum, Colocynthis, Gnaphalium Polycephalum, Hypericum Perforatum, Magnesia Phosphorica, Plumbum Metallicum, Rhus Tox, Arnica Montana | — Medicare Part D | — | — | — |
| Prazosin Hydrochloride Prazosin Hydrochloride | — Medicare Part D | — | — | — |
| TADLIQ Tadalafil | — Medicare Part D | — | — | — |
| Sarclisa isatuximab | — Medicare Part D | — | — | — |
| COMPLERA emtricitabine, rilpivirine hydrochloride, and tenofovir disoproxil fumarate | — Medicare Part D | — | — | — |
| ALOCRIL nedocromil sodium | — Medicare Part D | — | — | — |
| Estradiol ESTRADIOL | — Medicare Part D | — | — | — |
| Litfulo ritlecitinib | — Medicare Part D | — | — | — |
| CELECOXIB Celecoxib | — Medicare Part D | — | — | — |
| Cromolyn Sodium Oral Solution (Concentrate) Cromolyn Sodium | — Medicare Part D | — | — | — |
| Pulmozyme dornase alfa | — Medicare Part D | — | — | — |
| LOPERAMIDE HYDROCHLORIDE Loperamide Hydrochloride | — Medicare Part D | — | — | — |
| Micardis HCT telmisartan and hydrochlorothiazide | — Medicare Part D | — | — | — |
| Guanfacine guanfacine | — Medicare Part D | — | — | — |