Medicare Part D coverage · oxycodone hydrochloride · RxCUI 1049696
oxycodone hydrochloride 5 MG Oral Capsule
Per the CMS 2026 Part D formulary file, oxycodone hydrochloride 5 MG Oral Capsule is covered by 2,305 Medicare Part D plans (45.6% of enrollable products), averaging Tier 2.3, with prior authorization required on 2.5% of covering formularies.
- 45.6%
- Plan coverage
- 2,305
- Plans covering
- T2.3
- Avg tier
- 2.5%
- Prior auth required
What the CMS Formulary Data Shows for oxycodone hydrochloride 5 MG Oral Capsule
Per the CMS 2026 Part D formulary file, oxycodone hydrochloride 5 MG Oral Capsule (RxNorm concept RXCUI 1049696, generic name oxycodone hydrochloride) appears on 120 distinct formulary files spanning 2,305 Medicare Part D plan offerings - 45.6% 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 2.3.
Real-world access to oxycodone hydrochloride 5 MG Oral Capsule depends on utilization management as much as tier placement: 2.5% of covering formularies require prior authorization. 0% require step therapy. 92.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 2,133,988 Part D beneficiaries filled oxycodone hydrochloride 5 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $262,998,163 and an average per-beneficiary annual cost of $123.24. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry oxycodone hydrochloride 5 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 120
- Plans covering
- 2,305
- Coverage rate
- 45.6%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 2.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 92.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,133,988
- Total spending
- $262,998,163
- Avg per beneficiary
- $123.24
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering oxycodone hydrochloride 5 MG Oral Capsule
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| DualConnect (HMO D-SNP) | Santa Clara County Health Authority | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Generations Classic Rewards (HMO) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Classic Plus (HMO) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Chronic Care (HMO C-SNP) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Chronic Care Savings (HMO C-SNP) | Globalhealth, Inc. | T1 | No | $0 | OK |
Show the next 30 plans
| Generations Dual Support (HMO D-SNP) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Dual Premier (HMO D-SNP) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | No | $0 | CA |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| 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 |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Leon MediExtra (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMore (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | No | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $13.10 | PA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | No | $15.20 | IL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is oxycodone hydrochloride 5 MG Oral Capsule covered by Medicare Part D?
Yes, oxycodone hydrochloride 5 MG Oral Capsule is covered by 2,305 Medicare Part D plans (45.6% of all Part D formularies).
What tier is oxycodone hydrochloride 5 MG Oral Capsule on Medicare Part D plans?
oxycodone hydrochloride 5 MG Oral Capsule averages Tier 2.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does oxycodone hydrochloride 5 MG Oral Capsule require prior authorization?
2.5% of Part D formularies require prior authorization for oxycodone hydrochloride 5 MG Oral Capsule. Step therapy: 0%. Quantity limits: 92.5%.
How much does Medicare spend on oxycodone hydrochloride 5 MG Oral Capsule?
In 2023, total Medicare Part D spending on oxycodone hydrochloride 5 MG Oral Capsule was $262,998,163, covering 2,133,988 beneficiaries. The average spend per beneficiary was $123.24.
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
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