oxycodone-acetaminophen tablets

Opioid Analgesics — Long Acting Opioids

Also known as: Percocet

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 18 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via Percocet
Tier 3 - Non-Preferred Brand QL
BCBS Federal Standard Option 2026
via Percocet
Tier 3 - Non-Preferred Brand QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 18 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026
via Percocet
Tier 1 - Lowest Cost Generic QL
BCBSNC Blue Care 2026
via Percocet
Tier 1 - Lowest Cost Generic QL
BCBSNC Blue Value 2026
via Percocet
Tier 1 - Lowest Cost Generic QL
BCBSNC Blue Advantage 2026
via Percocet
Tier 1 - Lowest Cost Generic QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Percocet
Tier 1 - Lowest Cost Generic QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 18 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Preferred PA
NC Medicaid Preferred Drug List 2026
via Percocet
Non-Preferred PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 18 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Percocet
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via Percocet
Not Covered None
NC State Health Plan - HDHP 2026
via Percocet
Not Covered None
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