oxymorphone hydrochloride
Generic: oxymorphone hcl
7.5 MG — Extended Release Tablet
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| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Complete Gold | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Everyday Bronze | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Elite Bronze | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Silver | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Gold | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Complete Gold with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Silver with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Gold with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
20 plans| 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 | 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 | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
3 plans| 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 |
Blue Cross Blue Shield of NC
10 plans| 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 | Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Value 2026 | Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Advantage 2026 | Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Care 2026 | Tier 4 - Higher Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
Cigna
20 plans| 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 |
Medicare Part D
7 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| HealthSpring TotalCare (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
| HealthSpring True Choice (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
| HealthSpring Preferred Plus (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
| HealthSpring Preferred Savings (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
| HealthSpring Preferred Select (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
| HealthSpring Preferred (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 90 per 30 days | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | 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
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
via oxymorphone hcl tb12 |
Not Covered | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via oxymorphone hcl tb12 |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via oxymorphone hcl tb12 |
Not Covered | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Classic Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Classic Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Gold Classic Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Gold Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Classic | Tier 2 - Generic | — | — | ✓ | QL |
| Secure | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Classic 4700 | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| AIAN Cost Share | Tier 2 - Generic | — | — | ✓ | QL |
| AIAN Cost Share | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple PCP Saver | Tier 2 - Generic | — | — | ✓ | QL |
| Gold Elite Saver Plus | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Diabetes | Tier 2 - Generic | — | — | ✓ | QL |
| Secure | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Classic 4700 | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Classic | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple PCP Saver | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Gold Elite Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Standard (No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Standard (No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Standard (No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |