12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet
oxymorphone hydrochloride
RxCUI: 977923
Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
6.2%
Plan Coverage
316
Plans Covering
T3.1
Avg Tier
0%
Prior Auth Required
What the CMS Formulary Data Shows for 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet
Per the CMS 2026 Part D formulary file, 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet (RxNorm concept RXCUI 977923, generic name oxymorphone hydrochloride) appears on 21 distinct formulary files spanning 316 Medicare Part D plan offerings - 6.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.1.
Real-world access to 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 85.7% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet today.
Coverage Details
- Formularies covering
- 21
- Plans covering
- 316
- Coverage rate
- 6.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 85.7% of formularies
Tier Distribution Across Plans
13 plans
Tier 1, Preferred Generic
9 plans
Tier 2, Generic
2 plans
Tier 3, Preferred Brand
76 plans
Tier 4, Non-Preferred
Standalone Drug Plans (PDP) Covering 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet
9 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY | T4 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet
91 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T1 | No | $0 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T1 | No | $0 | CA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK HEALTH OPTIONS WEST VIRGINIA INC. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $0 | DE |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | No | $4.80 | FL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $13.10 | PA |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | GATEWAY HEALTH PLAN, INC. | T1 | No | $17.60 | PA |
| Highmark Health Options Duals Select (HMO D-SNP) | HIGHMARK BCBSD, INC. | T1 | No | $31.20 | DE |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T1 | No | $51.60 | NY |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Heart & Diabetes Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Health (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T2 | No | $0 | FL |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Heart & Diabetes (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| Gold Dialysis & Kidney (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T2 | No | $0 | AZ |
| VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) | VILLAGE SENIOR SERVICES CORPORATION | T3 | No | $0 | NY |
| VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) | VILLAGE SENIOR SERVICES CORPORATION | T3 | No | $0 | NY |
| Medicare BlueEssential (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueActive (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare BlueVital (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $0 | NY |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T4 | No | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T4 | No | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | No | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | No | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | No | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T4 | No | $0 | MI |
| Univera Medicare Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | EXCELLUS HEALTH PLAN COMMUNITY CARE LLC | T4 | No | $0 | NY |
| HealthSpring Preferred (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T4 | No | $0 | AZ |
| HealthSpring Alliance (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T4 | No | $0 | AZ |
| HealthSpring Preferred Savings (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T4 | No | $0 | AZ |
| HealthSpring Preferred Full Savings (HMO) | BRAVO HEALTH PENNSYLVANIA, INC. | T4 | No | $0 | AZ |
| HealthSpring Preferred GA (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | No | $0 | GA |
| HealthSpring Preferred (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. | T4 | No | $0 | GA |
Frequently Asked Questions
Is 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet covered by Medicare Part D?
Yes, 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet is covered by 316 Medicare Part D plans (6.2% of all Part D formularies).
What tier is 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet on Medicare Part D plans?
12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet averages Tier 3.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for 12 HR oxymorphone hydrochloride 5 MG Extended Release Oral Tablet. Step therapy: 0%. Quantity limits: 85.7%.
Read our methodology - how this data is sourced, computed, and verified.
Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial