oxymorphone hcl tb12

Generic: oxymorphone hcl

5mg, 7.5mg, 10mg, 15mg, 20mg, 30mg, 40mg

Also known as: oxymorphone hcl tb12 5mg, 7.5mg, 10mg, 15mg, 20mg, 30mg, 40mg oxymorphone hcl tb12 5mg, 7.5mg, 10mg,

Coverage by Insurer

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

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Elite Bronze with Atrium Health 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
Standard Expanded Bronze + Vision + Adult Dental via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Complete Gold via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug 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
Standard Expanded Bronze via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Silver via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Focused Silver with Atrium Health via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Complete Gold with Atrium Health via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Silver with Atrium Health via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold with Atrium Health via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug 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 with Atrium Health via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental via oxymorphone hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026 via oxymorphone hcl	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Basic Option 2026 via oxymorphone hcl	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Standard Option 2026 via oxymorphone hcl	Tier 1 - Generic	✓	—	—	PA

Blue Cross Blue Shield of NC

10 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Care 2026 via oxymorphone hcl	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Value 2026 via oxymorphone hcl	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Advantage 2026 via oxymorphone hcl	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Home with UNC Health Alliance 2026 via oxymorphone hcl	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Local 2026 via oxymorphone hcl	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Care 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 Local 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 Advantage 2026 via oxymorphone hydrochloride	Tier 4 - Higher Cost Brand	✓	—	✓ Restricted Access	PA \| QL

Medicare Part D

7 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
HealthSpring True Choice (PPO) 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 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
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 (HMO D-SNP) via oxymorphone hydrochloride	Tier 4 - Non-Preferred	—	—	✓ 90 per 30 days	QL

NC State Health Plan

6 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via oxymorphone hcl	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026 via oxymorphone hcl	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026 via oxymorphone hcl	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Not Covered	—	—	—	None

UnitedHealthcare

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026 via oxymorphone hcl	Unknown	—	—	✓	QL