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,
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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
Standard Gold + Vision + Adult Dental
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 + Vision + Adult Dental
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
Enhanced Asthma/COPD Care Silver with $0 Drug Options
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
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 + 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
Standard Expanded Bronze + Vision + Adult Dental
via oxymorphone hydrochloride 		Tier 2 - Generic ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Signature + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals
via oxymorphone hcl 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Premier + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Premier + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Signature + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + No Referrals
via oxymorphone hydrochloride 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via oxymorphone hcl 		Tier 1 - Generic ✓ — — PA
BCBS Federal Basic Option 2026
via oxymorphone hcl 		Tier 1 - Generic ✓ — — PA
BCBS Federal Focus 2026
via oxymorphone hcl 		Tier 1 - Generic ✓ — — PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 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 Care 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 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 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 Care 2026
via oxymorphone hydrochloride 		Tier 4 - Higher Cost Brand ✓ — ✓ Restricted Access PA | QL
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver 3500 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect myDiabetesCare Silver
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Gold 1500 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect myDiabetesCare Bronze
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze 7000 HSA Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Silver 4400 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Silver 3000 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Silver CMS Standard
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Silver RD CMS Standard
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Gold CMS Standard
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze RD CMS Standard
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Gold RD CMS Standard
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze CMS Standard
via oxymorphone hcl 		Tier 3 - Preferred Brand ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
HealthSpring TotalCare (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 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 Preferred (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
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 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 - 80/20 Plus PPO 2026
via oxymorphone hcl 		Tier 1 - Preferred Generic ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
NC State Health Plan - HDHP 2026 Not Covered — — — None
Source: CMS QHP JSON  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Breathe Easy with Enhanced COPD Benefits | 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 Diabetes | 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
Silver Simple Chronic Care CKM | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Bronze Classic Standard
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Silver Classic Standard
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Gold Classic Standard
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Silver Classic Standard | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Gold Classic Standard | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Bronze Elite + PCP Saver Plus
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Silver Classic
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Secure
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Bronze Classic 4700
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Bronze Classic Standard | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
AIAN Cost Share
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
AIAN Cost Share | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Silver Simple PCP Saver
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Gold Elite Saver Plus
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Silver Simple Diabetes
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Secure | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Bronze Classic 4700 | 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
Silver Classic | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Silver Simple Diabetes | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Silver Simple PCP Saver | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Gold Elite Saver Plus | with Atrium Health
via oxymorphone hydrochloride 		Tier 2 - Generic — — ✓ QL
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 17 hours, 40 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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 Essential ($0 Virtual Urgent Care, No Referrals
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Standard (No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard+ Dental + Vision (No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard (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 Silver Value ($0 Virtual Urgent Care, No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Standard (No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via oxymorphone hydrochloride 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
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