OXYCODONE HYDROCHLORIDE 5 mg Capsule
Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
7 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 2–4.
Lowest 30-day cost $5.00 at a preferred pharmacy. 7 of 7 plans apply a prior authorization, step therapy or quantity limit.
225 Medicare Advantage plans in PA, WV do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. PA: 181 plans · WV: 44 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 2Generic | $5.00 | $12.50 | $0.3839 | $69.10180 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $0.3839 | $69.10180 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $0.7460 | $13.4318 units |
|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $0.6074 | $21.8736 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.1790 | $21.2218 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $0.6110 | $22.0036 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $0.6054 | $21.7936 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.