Home › Agent Hub › Agent Tools › Part D coverage by drug › Oxycodone
Agent Tools
Oxycodone is the generic ingredient; brand versions: Oxycontin, Xtampza. What agents check before quoting it: how many 2026 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2026, 5,474 of 5,496 Medicare Part D and Medicare Advantage drug plans (99.6%) list Oxycodone on their formulary, across 326 of 328 formularies. The most common placement is tier 3 (3,773 plans, 68.9% of those covering it). 110 of the covering plans require prior authorization (2%), 0 step therapy and 5,160 a quantity limit.
1,973 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $14, 622 of them $0; 3,501 charge coinsurance instead — median 24% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,100 in 2026, covered drugs cost $0 for the rest of the year.
2025: 5,608 of 5,631 plans covered it (99.6%); 2026: 5,474 of 5,496 (99.6%).
Of 4,368 plans offered in both years, 0 added it to the formulary and 0 dropped it.
Among plans covering it both years, 358 moved it to a higher tier and 32 to a lower one; 10 added prior authorization and 0 removed it.
Medicare Part D paid for 9,170,713 30-day fills of Oxycodone in 2024 for about 2,777,711 enrollees, at an average total cost of $13.12 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Oxycodone and the rest of a client's list on every plan in their county.
Estimate Oxycodone costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 09/16/2026). CMS formulary data.