Medicare drug coverage

Oxycontin: 2027 Medicare Part D coverage

39 of 5,495 Part D plans (1%) list Oxycontin on their 2027 formulary, the plan's list of covered drugs (down 3 points from 2026). 97% of those require prior authorization, step therapy, or a quantity limit. Plan counts include both Medicare Advantage plans with drug coverage (5,172 MA-PD) and stand-alone drug plans (323 PDP).

License: a US government work, in the public domain (Public Domain Mark 1.0).

Data only, not plan advice. Confirm on Medicare.gov Plan Finder or 1-800-MEDICARE.

2027 compared with 2026

Oxycontin is number 127 by total Medicare Part D spending in 2024 ($338 million). Plans that list it most often put it on tier 3 (a tier is the cost level a plan puts a drug on; a lower tier usually costs less). Counts use 8 RxNorm products for this name.

Oxycontin Part D coverage, 2026 and 2027
Measure20262027Change
Part D plans in the file5,5185,495-23
Plans that list it220 (4%)39 (1%)-3 points
Prior authorization (of plans that list it)134 (61%)2 (5%)-56 points
Step therapy (of plans that list it)0 (0%)0 (0%)no change
Quantity limit (of plans that list it)219 (100%)38 (97%)-3 points
Any of the three (of plans that list it)219 (100%)38 (97%)-3 points
Not listed or restricted (of all plans)5,517 (100%)5,494 (100%)no change

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Source: CMS 2026 Part D formulary file (basic drugs and plan information), as of September 30, 2026. Publisher page

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Formulary tier

Oxycontin formulary tier, 2026 and 2027
Tier2026 plans2027 plans
Tier 150 (23%)1 (3%)
Tier 218 (8%)1 (3%)
Tier 353 (24%)29 (74%)
Tier 499 (45%)8 (21%)

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Source: CMS 2026 Part D formulary file (basic drugs and plan information), as of September 30, 2026. Publisher page

Plan by plan, 2026 to 2027

4,380 plan IDs are in both files. 0 of them (0%) added prior authorization, step therapy, or a quantity limit for Oxycontin, and 135 stopped listing it.

Oxycontin: plans in both 2026 and 2027
Plan by planPlans
Same plan ID in both years4,380
Listed it in 2026, not in 2027135 (3%)
Listed it in 2027, not in 20260 (0%)
Moved it to a higher tier0 (0%)
Added prior authorization0 (0%)
Added step therapy0 (0%)
Added a quantity limit0 (0%)
Added at least one of the three0 (0%)
Removed at least one of the three0 (0%)
Plan IDs new in 20271,115
2026 plan IDs not in the 2027 file1,138

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Source: CMS 2026 Part D formulary file (basic drugs and plan information), as of September 30, 2026. Publisher page

States from most to least restrictive

Share of 2027 Part D plans offered in each state that leave Oxycontin off the formulary or list it with prior authorization, step therapy, or a quantity limit. 50 states tie for the highest share, 100%; Wisconsin ranks last at 99%. States at the same share are ordered by the prior authorization or step therapy share; states equal on both shares share a rank, marked Tied.

States from most to least restrictive for Oxycontin, 2027
RankState2027 plansNot listed or restrictedPrior auth or step therapyChange from 2026
1Oregon92100%1%no change
Tied 2California397100%0%no change
Tied 2Alaska9100%0%no change
Tied 2Alabama115100%0%no change
Tied 2Arkansas86100%0%no change
Tied 2Arizona148100%0%no change
Tied 2Colorado106100%0%no change
Tied 2Connecticut54100%0%no change
Tied 2District of Columbia21100%0%no change
Tied 2Delaware43100%0%no change
Tied 2Florida549100%0%no change
Tied 2Georgia151100%0%no change
Tied 2Hawaii50100%0%no change
Tied 2Iowa64100%0%no change
Tied 2Idaho45100%0%no change
Tied 2Illinois133100%0%no change
Tied 2Indiana140100%0%no change
Tied 2Kansas84100%0%no change
Tied 2Kentucky123100%0%no change
Tied 2Louisiana126100%0%no change
Tied 2Massachusetts92100%0%no change
Tied 2Maryland49100%0%no change
Tied 2Maine52100%0%no change
Tied 2Michigan183100%0%no change
Tied 2Minnesota63100%0%no change
Tied 2Missouri171100%0%no change
Tied 2Mississippi105100%0%no change
Tied 2Montana27100%0%no change
Tied 2North Carolina177100%0%no change
Tied 2North Dakota26100%0%no change
Tied 2Nebraska51100%0%no change
Tied 2New Hampshire25100%0%no change
Tied 2New Jersey74100%0%no change
Tied 2New Mexico68100%0%no change
Tied 2Nevada100100%0%no change
Tied 2New York215100%0%no change
Tied 2Ohio173100%0%no change
Tied 2Oklahoma81100%0%no change
Tied 2Pennsylvania324100%0%no change
Tied 2Rhode Island29100%0%no change
Tied 2South Carolina91100%0%no change
Tied 2South Dakota30100%0%no change
Tied 2Tennessee157100%0%no change
Tied 2Texas412100%0%no change
Tied 2Utah53100%0%no change
Tied 2Virginia145100%0%no change
Tied 2Vermont14100%0%no change
Tied 2Washington114100%0%no change
Tied 2West Virginia70100%0%no change
Tied 2Wyoming13100%0%no change
51Wisconsin9799%0%no change

Source: CMS CY2027 landscape file (states and parent organizations), as of September 30, 2026. Publisher page

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

By parent organization

164 parent organizations offer 2027 Part D plans. Humana Inc. has the most, 884, and 100% of them leave Oxycontin off or restrict it.

Oxycontin coverage by parent organization, 2027
Parent organization2027 plans ↓List itRestrict it (of listing)Not listed or restrictedChange from 2026Plans that added a restriction
DOCTORS HEALTHCARE PLANS, INC.90%none list it100%no change0
EmblemHealth, Inc.90%none list it100%no change0
Perennial Consortium, LLC90%none list it100%no change0
West Virginia United Health System, Inc.90%none list it100%no change0
Astiva Health Holdings Incorporated80%none list it100%no change0
Healthfirst, Inc.80%none list it100%no change0
Longevity Health Founders, LLC80%none list it100%no change0
MVP Health Care, Inc.80%none list it100%no change0
Martin's Point Health Care, Inc.80%none list it100%no change0
Triton Health Systems, L.L.C.80%none list it100%no change0
Allina Health and Aetna Insurance Holding Company70%none list it100%no change0
Baylor Scott & White Health70%none list it100%no change0
Blue Cross and Blue Shield of Massachusetts, Inc.70%none list it100%no change0
HealthPartners, Inc.70%none list it100%no change0
Johns Hopkins Healthcare LLC70%none list it100%no change0
Network Health, Inc.7100%100%100%no change0
Singh Holdings LLC70%none list it100%no change0
Baystate Health, Inc.60%none list it100%no change0
Blue Cross Blue Shield of Arizona60%none list it100%no change0
Blue Cross Blue Shield of Kansas60%none list it100%no change0
BlueCross BlueShield of South Carolina (BCBSSC)60%none list it100%no change0
CareSource617%0%83%-17 points0
Clever Care Health Plan, Inc.60%none list it100%no change0
Eternal Health of Delaware, Inc.60%none list it100%no change0
Hawaii Medical Service Association60%none list it100%no change0

Source: CMS CY2027 landscape file (states and parent organizations), as of September 30, 2026. Publisher page

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Near it by Part D spending

About this data

A plan here is one Part D plan as the CMS formulary files list it: contract, plan, and segment. That covers Medicare Advantage plans with drug coverage and stand-alone drug plans. A plan lists a drug when its formulary has a row for any RxNorm product of that name. When it has several, the row with the lowest tier is the one counted, and restricted means that row has prior authorization, step therapy, or a quantity limit.

A plan with no row for the drug counts as not listing it. That can be a product the file codes another way, so read a low count as a lookup result, not a coverage decision. A state counts every plan the CMS landscape file offers there. Parent organizations are named as CMS names them. The drug list is the top 200 by total Part D spending.

Source: CMS 2027 Part D formulary file (basic drugs and plan information), as of October 8, 2026. Publisher page

Source: CMS CY2027 landscape file (states and parent organizations), as of September 30, 2026. Publisher page

Source: CMS Medicare Part D Spending by Drug, 2024 data, as of June 25, 2026. Publisher page

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