Does NH Local HMO Gold 2000 Standard + $0 Rx list + $0 Virtual Urgent Care cover oxycodone?
NH Local HMO Gold 2000 Standard + $0 Rx list + $0 Virtual Urgent Care
59025-59025NH0370098-0 · ACA · ACA Marketplace
oxycodone
oxycodoneunder NH Local HMO Gold 2000 Standard + $0 Rx list + $0 Virtual Urgent Care
Covered — some forms require prior authorization
12 of 28 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$15per 30-day fill
From the first fill — no deductible on this drug.
This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.
Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.
- Tier
- Generic
- Approval first
- Required
- Try another first
- No
- Amount limit
- Yes
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.
Covered forms and strengths (28)
- Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone 18 MG Extended Release Oral Capsule [Xtampza]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone 27 MG Extended Release Oral Capsule [Xtampza]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone 36 MG Extended Release Oral Capsule [Xtampza]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone hydrochloride 10 MG Extended Release Oral Tablet [Oxycontin]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone hydrochloride 15 MG Extended Release Oral Tablet [Oxycontin]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone hydrochloride 20 MG Extended Release Oral Tablet [Oxycontin]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone hydrochloride 30 MG Extended Release Oral Tablet [Oxycontin]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone hydrochloride 60 MG Extended Release Oral Tablet [Oxycontin]Approval firstAmount limit
- Abuse-Deterrent 12 HR oxycodone hydrochloride 80 MG Extended Release Oral Tablet [Oxycontin]Approval firstAmount limit
- Abuse-Deterrent oxycodone hydrochloride 10 MG Oral TabletAmount limit
- Abuse-Deterrent oxycodone hydrochloride 10 MG Oral Tablet [Roxybond]Amount limit
- Abuse-Deterrent oxycodone hydrochloride 15 MG Oral TabletAmount limit
- Abuse-Deterrent oxycodone hydrochloride 15 MG Oral Tablet [Roxybond]Amount limit
- Abuse-Deterrent oxycodone hydrochloride 30 MG Oral TabletAmount limit
- Abuse-Deterrent oxycodone hydrochloride 30 MG Oral Tablet [Roxybond]Amount limit
- Abuse-Deterrent oxycodone hydrochloride 5 MG Oral TabletAmount limit
- Abuse-Deterrent oxycodone hydrochloride 5 MG Oral Tablet [Roxybond]Amount limit
- oxycodone hydrochloride 1 MG/ML Oral Solution
- oxycodone hydrochloride 10 MG Oral Tablet
- oxycodone hydrochloride 15 MG Oral Tablet
- oxycodone hydrochloride 20 MG Oral Tablet
- oxycodone hydrochloride 20 MG/ML Oral Solution
- oxycodone hydrochloride 30 MG Oral Tablet
- oxycodone hydrochloride 5 MG Oral Capsule
- oxycodone hydrochloride 5 MG Oral Tablet