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 |
|---|---|---|---|---|
| KIMMTRAK TEBENTAFUSP | — Medicare Part D | — | — | — |
| NEVIRAPINE nevirapine | — Medicare Part D | — | — | — |
| Bromfenac Ophthalmic Solution 0.09% | — Medicare Part D | — | — | — |
| Detrol LA tolterodine tartrate | — Medicare Part D | — | — | — |
| LEUPROLIDE ACETATE DEPOT leuprolide acetate | — Medicare Part D | — | — | — |
| AUVI-Q AUVI-Q | — Medicare Part D | — | — | — |
| Memantine Hydrochloride Memantine Hydrochloride | — Medicare Part D | — | — | — |
| SORILUX calcipotriene | — Medicare Part D | — | — | — |
| AVTOZMA tocilizumab | — Medicare Part D | — | — | — |
| Deferoxamine Mesylate Deferoxamine mesylate | — Medicare Part D | — | — | — |
| NITROLINGUAL Nitroglycerin | — Medicare Part D | — | — | — |
| Glycopyrrolate Oral Solution Glycopyrrolate | — Medicare Part D | — | — | — |
| OXYCODONE HYDROCHLORIDE OXYCODONE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Zevalin ibritumomab tiuxetan | — Medicare Part D | — | — | — |
| Cefuroxime Axetil Cefuroxime Axetil | — Medicare Part D | — | — | — |
| NAPROXEN Naproxen | — Medicare Part D | — | — | — |
| Portia Levonorgestrel and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Humatin PAROMOMYCIN SULFATE | — Medicare Part D | — | — | — |
| Cephalexin Cephalexin | — Medicare Part D | — | — | — |
| CLOFARABINE Clofarabine | — Medicare Part D | — | — | — |
| Sevelamer Carbonate SEVELAMER CARBONATE | — Medicare Part D | — | — | — |
| Buprenorphine and Naloxone Buprenorphine and Naloxone | — Medicare Part D | — | — | — |
| METHOTREXATE Methotrexate | — Medicare Part D | — | — | — |
| Davimet-M Multivitamin | — Medicare Part D | — | — | — |
| Recorlev Levoketoconazole | — Medicare Part D | — | — | — |
| Amlodipine, Valsartan and Hydrochlorothiazide Amlodipine, Valsartan and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Losartan potassium Tablets, 25 mg LOSARTAN POTASSIUM | — Medicare Part D | — | — | — |
| Triamterene Triamterene and Hydrochlorothiazide | — Medicare Part D | — | — | — |
| Nicomide niacinamide, zinc glycinate, folic acid, cupric oxide, selenium and chromium | — Medicare Part D | — | — | — |
| IMVEXXY estradiol | — Medicare Part D | — | — | — |
| Balziva Norethindrone and Ethinyl Estradiol | — Medicare Part D | — | — | — |
| Cayston aztreonam | — Medicare Part D | — | — | — |
| LISINOPRIL AND HYDROCHLOROTHIAZIDE Lisinopril and Hydrochlorothiazide Tablets | — Medicare Part D | — | — | — |
| RIVFLOZA nedosiran | — Medicare Part D | Yes | — | — |
| Niva Thyroid thyroid, porcine | — Medicare Part D | — | — | — |
| hydrocortisone valerate cream Hydrocortisone Valerate | — Medicare Part D | — | — | — |
| Estring estradiol | — Medicare Part D | — | — | — |
| SOVUNA Hydroxychloroquine Sulfate | — Medicare Part D | — | — | — |
| DIGOXIN DIGOXIN | — Medicare Part D | — | — | — |
| alogliptin and metformin hydrochloride alogliptin and metformin hydrochloride | — Medicare Part D | — | — | — |
| Bortezomib BORTEZOMIB | — Medicare Part D | — | — | — |
| Ropivacaine Hydrochloride Ropivacaine Hydrochloride | — Medicare Part D | — | — | — |
| Potassium Phosphate Leucine, Phenylalanine, Lysine, Methionine, Isoleucine, Valine, Histidine, Threonine, Tryptophan, Alanine, Glycine, Arginine, Proline, Serine, Tyrosine, Sodium Acetate, Dibasic Potassium Phosphate, Magnesium Chloride, Sodium Chloride, Calcium Chloride, Dextrose | — Medicare Part D | — | — | — |
| Oxygen/Helium 20/80 Oxygen/Helium 20/80 | — Medicare Part D | — | — | — |
| PreviDent Fresh Mint, PreviDent Very Berry | — Medicare Part D | — | — | — |
| Tarpeyo budesonide | — Medicare Part D | — | — | — |
| Levothyroxine Sodium Levothyroxine Sodium | — Medicare Part D | — | — | — |
| CYTARABINE cytarabine | — Medicare Part D | — | — | — |
| Anoro Ellipta umeclidinium bromide and vilanterol trifenatate | — Medicare Part D | — | — | — |
| RIZATRIPTAN BENZOATE Rizatriptan Benzoate | — Medicare Part D | — | — | — |