Medicare Part D coverage · Abuse-Deterrent · RxCUI 1049586
Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin]
Per the CMS 2026 Part D formulary file, Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] is covered by 189 Medicare Part D plans (3.7% of enrollable products), averaging Tier 2.4, with prior authorization required on 58.8% of covering formularies.
- 3.7%
- Plan coverage
- 189
- Plans covering
- T2.4
- Avg tier
- 58.8%
- Prior auth required
What the CMS Formulary Data Shows for Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin]
Per the CMS 2026 Part D formulary file, Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] (RxNorm concept RXCUI 1049586, generic name Abuse-Deterrent) appears on 51 distinct formulary files spanning 189 Medicare Part D plan offerings - 3.7% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 2.4.
Real-world access to Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] depends on utilization management as much as tier placement: 58.8% of covering formularies require prior authorization. 0% require step therapy. 98% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 65,061 Part D beneficiaries filled Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] in 2023, with total plan-and-beneficiary spending of $390,573,654 and an average per-beneficiary annual cost of $6,003.19. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] today.
Coverage Details
- Formularies covering
- 51
- Plans covering
- 189
- Coverage rate
- 3.7%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 58.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 98% of formularies
2023 Medicare Spending
- Beneficiaries
- 65,061
- Total spending
- $390,573,654
- Avg per beneficiary
- $6,003.19
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | No | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | No | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | No | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
Show the next 30 plans
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | No | $14.70 | NC |
| KeyCare Advantage (HMO I-SNP) | Isnp Ventures, LLC | T1 | Yes | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | American Health Plan OF MS, Inc. | T1 | No | $23.80 | MS |
| Senior Care (HMO I-SNP) | Lifeworks Advantage, LLC | T1 | Yes | $24.60 | VA |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | Georgia Assurance, Inc. | T1 | No | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | Georgia Assurance, Inc. | T1 | No | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | American Health Plan, Inc. | T1 | No | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | Simpra Advantage, Inc. | T1 | No | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | Oklahoma Superior Select, Inc. | T1 | No | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC Advantage, LLC | T1 | Yes | $31.00 | MO, NC, SC, TN |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Ohio, Inc. | T1 | Yes | $31.40 | OH |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | Yes | $32.70 | PA |
| American Health Advantage of Pennsylvania (HMO I-SNP) | American Health Plan OF Pennsylvania Inc | T1 | No | $32.70 | PA |
| Lagniappe Advantage (PPO I-SNP) | Lagniappe Advantage Insurance Company | T1 | Yes | $32.90 | LA |
| American Health Advantage of Louisiana (HMO I-SNP) | Dignity Care Corporation | T1 | No | $32.90 | LA |
| Perennial Advantage Strive (HMO I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | Yes | $35.20 | CO |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier North Carolina, LLC | T1 | Yes | $35.70 | SC |
| PruittHealth Premier (HMO I-SNP) | Pruitthealth Premier North Carolina, LLC | T1 | Yes | $36.20 | NC |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Liberty Advantage, LLC | T1 | No | $36.20 | NC |
| American Health Advantage of Utah (HMO I-SNP) | American Health Plan OF UT, Inc. | T1 | No | $37.60 | UT |
| American Health Advantage of Idaho (HMO I-SNP) | American Health Plan OF UT, Inc. | T1 | No | $37.60 | ID |
| American Health Advantage of Indiana (HMO I-SNP) | American Health Plan OF Indiana Inc | T1 | No | $38.40 | IN |
| Iowa Health Advantage (HMO I-SNP) | American Health Plan OF Iowa Inc | T1 | No | $41.50 | IA |
| Iowa Health Advantage Choice (HMO I-SNP) | American Health Plan OF Iowa Inc | T1 | No | $41.50 | IA |
| American Health Advantage of Missouri (HMO I-SNP) | American Health Plan OF Missouri, Inc. | T1 | No | $43.00 | MO |
| American Health Advantage of Missouri Choice (HMO I-SNP) | American Health Plan OF Missouri, Inc. | T1 | No | $43.00 | MO |
| Kansas Health Advantage (HMO I-SNP) | Kansas Superior Select, Inc. | T1 | No | $55.20 | KS |
| Kansas Health Advantage Choice (HMO I-SNP) | Kansas Superior Select, Inc. | T1 | No | $55.20 | KS |
| KeyCare Advantage Plus (HMO C-SNP) | Isnp Ventures, LLC | T2 | Yes | $0 | MD |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] covered by Medicare Part D?
Yes, Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] is covered by 189 Medicare Part D plans (3.7% of all Part D formularies).
What tier is Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] on Medicare Part D plans?
Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] averages Tier 2.4 across Part D plans, ranging from Tier 1 to Tier 5.
Does Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] require prior authorization?
58.8% of Part D formularies require prior authorization for Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin]. Step therapy: 0%. Quantity limits: 98%.
How much does Medicare spend on Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin]?
In 2023, total Medicare Part D spending on Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin] was $390,573,654, covering 65,061 beneficiaries. The average spend per beneficiary was $6,003.19.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
Similar prior-authorization rate
- cyproheptadine hydrochloride 4 MG Oral Tablet 58.5% PA
- {32 (24 HR gepirone 18.2 MG Extended Release Oral Tablet [Exxua]) } Pack [Exxua Titration Pack] 59.1% PA
- carisoprodol 350 MG Oral Tablet 58.3% PA
- Timothy grass pollen extract 2800 BAU Sublingual Tablet [Grastek] 58.3% PA
- acetaminophen 325 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule 58.2% PA
- acetaminophen 300 MG / butalbital 50 MG / caffeine 40 MG Oral Capsule 57.8% PA