oxycodone hydrochloride 5 MG Oral Capsule
oxycodone hydrochloride
RxCUI: 1049696
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 121 distinct formulary files spanning 2,307 Medicare Part D plan offerings - 45.5% 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 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. 92.6% 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 $263,023,627 and an average per-beneficiary annual cost of $123.25. 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
- 121
- Plans covering
- 2,307
- Coverage rate
- 45.5%
- 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
- 92.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 2,133,988
- Total spending
- $263,023,627
- Avg per beneficiary
- $123.25
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering oxycodone hydrochloride 5 MG Oral Capsule
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Wellcare Simple (HMO-POS) | WELLCARE OF CONNECTICUT, INC. | T2 | No | No | $0 | CT |
| Wellcare Giveback (HMO-POS) | WELLCARE OF CONNECTICUT, INC. | T2 | No | No | $0 | CT |
Medicare Advantage Plans (MA-PD) Covering oxycodone hydrochloride 5 MG Oral Capsule
98 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 |
| 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 |
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 2,307 Medicare Part D plans (45.5% 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: 92.6%.
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 $263,023,627, covering 2,133,988 beneficiaries. The average spend per beneficiary was $123.25.
Read our methodology - how this data is sourced, computed, and verified.