Medicare Part D coverage · Abuse-Deterrent · RxCUI 1791560
Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza]
Per the CMS 2026 Part D formulary file, Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] is covered by 923 Medicare Part D plans (18.3% of enrollable products), averaging Tier 3.2, with prior authorization required on 11.5% of covering formularies.
- 18.3%
- Plan coverage
- 923
- Plans covering
- T3.2
- Avg tier
- 11.5%
- Prior auth required
What the CMS Formulary Data Shows for Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza]
Per the CMS 2026 Part D formulary file, Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] (RxNorm concept RXCUI 1791560, generic name Abuse-Deterrent) appears on 26 distinct formulary files spanning 923 Medicare Part D plan offerings - 18.3% 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 3.2.
Real-world access to Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] depends on utilization management as much as tier placement: 11.5% of covering formularies require prior authorization. 0% require step therapy. 30.8% 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 Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] today.
Coverage Details
- Formularies covering
- 26
- Plans covering
- 923
- Coverage rate
- 18.3%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 11.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 30.8% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | No | $15.20 | IL |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Kentucky | T1 | No | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $43.00 | MO |
| eternalHealth Forever (HMO) | Eternalhealth, Inc. | T3 | No | $0 | MA |
| eternalHealth Freedom (PPO) | Eternalhealth, Inc. | T3 | No | $0 | MA |
| eternalHealth Give Back (PPO) | Eternalhealth, Inc. | T3 | No | $0 | MA |
| eternalHealth Horizon (HMO) | Eternalhealth OF Arizona Inc | T3 | No | $0 | AZ |
| eternalHealth Grand Give Back (HMO) | Eternalhealth OF Arizona Inc | T3 | No | $0 | AZ |
Show the next 30 plans
| eternalHealth + Fry's Medicare Advantage (HMO) | Eternalhealth OF Arizona Inc | T3 | No | $0 | AZ |
| Senior Care Plus Essential plan (HMO) | Hometown Health Plan, Inc. | T3 | No | $0 | NV |
| Senior Care Plus Complete Plan (HMO) | Hometown Health Plan, Inc. | T3 | No | $0 | NV |
| Renown Preferred Plan by Senior Care Plus (HMO) | Hometown Health Plan, Inc. | T3 | No | $0 | NV |
| Senior Care Plus Extensive Duals Plan (HMO D-SNP) | Hometown Health Plan, Inc. | T3 | No | $0 | NV |
| Senior Care Plus Enriched Duals Plan (HMO D-SNP) | Hometown Health Plan, Inc. | T3 | No | $0 | NV |
| MyAdvocate Medicare Advantage SILVER (HMO-POS) | Beshp, Inc. | T3 | No | $0 | NE |
| Great Plain Medicare Advantage Gold (HMO I-SNP) | Sanford Health Plan | T3 | No | $0 | IA, SD |
| Align ChoicePlus (PPO) | Sanford Health Plan OF Minnesota | T3 | No | $0 | MN |
| Great Plains Medicare Advantage Gold (HMO I-SNP) | Good Samaritan Insurance Plan OF Nebraska, Inc. | T3 | No | $0 | NE |
| Align ChoicePlus (PPO) | Sanford Health Plan | T3 | No | $0 | IA, SD |
| Align ChoicePlus (PPO) | Sanford Health Plan | T3 | No | $0 | ND |
| Great Plains Medicare Advantage Gold (HMO I-SNP) | Sanford Health Plan | T3 | No | $0 | ND |
| Align Dual Partnership (HMO D-SNP) | Sanford Health Plan | T3 | No | $0 | ND |
| Ally Rx (HMO D-SNP) | Security Health Plan OF Wisconsin, Inc. | T3 | No | $0 | WI |
| Esteem Rx (HMO-POS) | Security Health Plan OF Wisconsin, Inc. | T3 | No | $0 | WI |
| BlueCross Total Value (PPO) | Bluecross AND Blueshield OF South Carolina | T3 | No | $0 | SC |
| BlueCross Total Value (PPO) | Bluecross AND Blueshield OF South Carolina | T3 | No | $0 | SC |
| BlueCross Total Value (PPO) | Bluecross AND Blueshield OF South Carolina | T3 | No | $0 | SC |
| Blue Best Life Classic (HMO) | Medisun, Inc. | T3 | No | $0 | AZ |
| Blue Best Life Classic (HMO) | Medisun, Inc. | T3 | No | $0 | AZ |
| BlueRI for Duals (HMO D-SNP) | Blue Cross & Blue Shield OF Rhode Island | T3 | Yes | $0 | RI |
| BlueCHiP for Medicare Essential (HMO-POS) | Blue Cross & Blue Shield OF Rhode Island | T3 | Yes | $0 | RI |
| UPMC for Life HMO Premier Rx (HMO) | Upmc Health Plan, Inc. | T3 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | Upmc FOR YOU, Inc | T3 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | Upmc FOR YOU, Inc | T3 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | Upmc Health Network, Inc. | T3 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | Upmc Health Network, Inc. | T3 | Yes | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | Upmc Health Network, Inc. | T3 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | Upmc Health Coverage, Inc. | T3 | Yes | $0 | PA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] covered by Medicare Part D?
Yes, Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] is covered by 923 Medicare Part D plans (18.3% of all Part D formularies).
What tier is Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] on Medicare Part D plans?
Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] averages Tier 3.2 across Part D plans, ranging from Tier 1 to Tier 4.
Does Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza] require prior authorization?
11.5% of Part D formularies require prior authorization for Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza]. Step therapy: 0%. Quantity limits: 30.8%.
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
- vortioxetine 10 MG Oral Tablet [Trintellix] T3.2
- benzoyl peroxide 0.05 MG/MG / erythromycin 0.03 MG/MG Topical Gel T3.2
- arformoterol 0.0075 MG/ML Inhalation Solution T3.2
- magnesium sulfate 225 MG / potassium chloride 188 MG / sodium sulfate 1479 MG Oral Tablet [Sutab] T3.2
- crisaborole 0.02 MG/MG Topical Ointment [Eucrisa] T3.2
- {56 (amoxicillin 500 MG Oral Capsule) / 28 (clarithromycin 500 MG Oral Tablet) / 28 (vonoprazan 20 MG Oral Tablet) } Pack [Voquezna 14 Day TriplePak 20;500;500] T3.2
Similar prior-authorization rate
- 1.6 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] 11.5% PA
- 2.4 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] 11.5% PA
- 3.2 ML aripiprazole lauroxil 276 MG/ML Prefilled Syringe [Aristada] 11.5% PA
- 3.9 ML aripiprazole lauroxil 273 MG/ML Prefilled Syringe [Aristada] 11.5% PA
- 2.4 ML aripiprazole lauroxil 281.3 MG/ML Prefilled Syringe [Aristada] 11.5% PA
- 50 ML clindamycin 6 MG/ML Injection 11.5% PA