FillMapImperial Standard Bronze

Does Imperial Standard Bronze cover oxycodone?

Imperial Standard Bronze
85533-85533AZ0010001-0 · ACA · ACA Marketplace
oxycodone
oxycodoneunder Imperial Standard Bronze
Covered — the conditions depend on which form
Not the same for every form: 1 of 33 need your plan’s approval first, and 15 of 33 usually need a preferred medication tried first. Check your exact form in the list below — your doctor’s office handles either.
What you'd pay
$25per 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
Required
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 (33)

  • Abuse-Deterrent 12 HR oxycodone 13.5 MG Extended Release Oral Capsule [Xtampza]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone 18 MG Extended Release Oral Capsule [Xtampza]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone 27 MG Extended Release Oral Capsule [Xtampza]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone 36 MG Extended Release Oral Capsule [Xtampza]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 10 MG Extended Release Oral Tablet [Oxycontin]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 15 MG Extended Release Oral Tablet [Oxycontin]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 20 MG Extended Release Oral TabletTry another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 20 MG Extended Release Oral Tablet [Oxycontin]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 30 MG Extended Release Oral Tablet [Oxycontin]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral TabletTry another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 40 MG Extended Release Oral Tablet [Oxycontin]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 60 MG Extended Release Oral Tablet [Oxycontin]Try another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 80 MG Extended Release Oral TabletTry another firstAmount limit
  • Abuse-Deterrent 12 HR oxycodone hydrochloride 80 MG Extended Release Oral Tablet [Oxycontin]Try another 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 SolutionAmount limit
  • oxycodone hydrochloride 10 MG Oral TabletAmount limit
  • oxycodone hydrochloride 15 MG Oral TabletAmount limit
  • oxycodone hydrochloride 15 MG Oral Tablet [Roxicodone]Amount limit
  • oxycodone hydrochloride 20 MG Oral TabletAmount limit
  • oxycodone hydrochloride 20 MG/ML Oral SolutionApproval firstAmount limit
  • oxycodone hydrochloride 30 MG Oral TabletAmount limit
  • oxycodone hydrochloride 30 MG Oral Tablet [Roxicodone]Amount limit
  • oxycodone hydrochloride 5 MG Oral CapsuleAmount limit
  • oxycodone hydrochloride 5 MG Oral TabletAmount limit

← All coverage for oxycodone