oxycodone myristate

13.5 mg, 18 mg, 27 mg, 36 mg, 9 mg — Extended Release Capsule

Also known as: XTAMPZA ER

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 6 hours, 41 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	—	None