Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza]
Abuse-Deterrent
RxCUI: 1790533
What the CMS Formulary Data Shows for Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza]
Per the CMS 2026 Part D formulary file, Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza] (RxNorm concept RXCUI 1790533, generic name Abuse-Deterrent) appears on 27 distinct formulary files spanning 936 Medicare Part D plan offerings - 18.5% 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 9 MG Extended Release Oral Capsule [Xtampza] depends on utilization management as much as tier placement: 11.1% of covering formularies require prior authorization. 0% require step therapy. 29.6% 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 9 MG Extended Release Oral Capsule [Xtampza] today.
Coverage Details
- Formularies covering
- 27
- Plans covering
- 936
- Coverage rate
- 18.5%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 11.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 29.6% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering Abuse-Deterrent 12 HR oxycodone 9 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 Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $0 | MD |
| 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 Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| 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 |
| 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 |
Frequently Asked Questions
Is Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza] covered by Medicare Part D?
Yes, Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza] is covered by 936 Medicare Part D plans (18.5% of all Part D formularies).
What tier is Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza] on Medicare Part D plans?
Abuse-Deterrent 12 HR oxycodone 9 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 9 MG Extended Release Oral Capsule [Xtampza] require prior authorization?
11.1% of Part D formularies require prior authorization for Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza]. Step therapy: 0%. Quantity limits: 29.6%.
Read our methodology - how this data is sourced, computed, and verified.