oxymorphone hcl
20mg, 30mg, 40mg — Tablet
Also known as:
oxymorphone hcl tabs 5mg, 10mg
oxymorphone hcl tab 5 mg, 10 mg
oxymorphone hcl tabs 5mg, 10mg; tb12 5mg, 7.5mg, 10mg, 15mg
oxymorphone hcl tb12 20mg, 30mg, 40mg
oxyMORphone HCl ER Oral Tablet Extended Release
oxyMORphone HCl Oral Tablet
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Focused Silver with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Elite Bronze
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Silver
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Gold
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Silver + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Gold + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Complete Gold
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Complete Gold + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Elite Bronze + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via oxymorphone hydrochloride |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
21 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 1 - Generic | ✓ | — | — | PA |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | ✓ | — | — | PA |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Local 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Advantage 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Local 2026
via oxymorphone hydrochloride |
Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Advantage 2026
via oxymorphone hydrochloride |
Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via oxymorphone hydrochloride |
Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Value 2026
via oxymorphone hydrochloride |
Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Care 2026
via oxymorphone hydrochloride |
Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Silver 5000 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Bronze 5500 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Bronze 6500 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Silver RD CMS Standard | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Bronze RD CMS Standard | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Gold 1500 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect myDiabetesCare Silver | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect myDiabetesCare Bronze | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Gold CMS Standard | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Silver CMS Standard | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Bronze CMS Standard | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Silver 3000 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Silver 3600 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Gold RD CMS Standard | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 3 - Preferred Brand | ✓ | — | — | PA |
Medicare Part D
7 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
HealthSpring Preferred Savings (HMO)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
|
HealthSpring Preferred Select (HMO)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
|
HealthSpring True Choice (PPO)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
|
HealthSpring TotalCare (HMO D-SNP)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
|
HealthSpring Preferred (HMO)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
|
HealthSpring Preferred Plus (HMO)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - 70/30 Standard PPO 2026
via oxymorphone hcl tb12 |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via oxymorphone hcl tb12 |
Not Covered | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via oxymorphone hcl tb12 |
Not Covered | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Chronic Care CKM | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Simple Diabetes | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Gold Elite Saver Plus | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple PCP Saver | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Diabetes | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
AIAN Cost Share | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
AIAN Cost Share
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Classic 4700 | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Secure | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Gold Classic Standard | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Classic Standard | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Classic Standard | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Gold Classic Standard
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Classic Standard
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Classic Standard
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Diabetes
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Gold Elite Saver Plus
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple PCP Saver
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Classic 4700
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Secure
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Classic
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Elite + PCP Saver Plus
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Classic | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via oxymorphone hydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via oxymorphone hydrochloride |
Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |