Does Medicare Cover Oxycontin?

Mike Olmos by Mike Olmos | Licensed since 2010
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This article was updated on: 09/10/2018

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What is OxyContin?

OxyContin (generic name: oxycodone), is a medication that may be prescribed to relieve moderate to severe pain, such as after an injury or surgical procedure, reports the National Institutes of Health (NIH). OxyContin belongs to a class of drugs called opiate (narcotic) analgesics.

According to the FDA, OxyContin poses risks for addiction because it contains oxycodone, an ingredient derived from opium that can produce feelings of euphoria. Misuse or abuse of OyxContin can lead to serious respiratory problems or death.

Addiction to prescription opioids such as OxyContin has risen sharply in recent years, and 1.9 million Americans suffer from non-medical prescription opioid use disorder, according to the National Institutes of Health.  If your doctor prescribes OyxContin for you or a loved one, you may want to talk to your doctor about the risks, and be sure to follow dosage instructions carefully.

What is OxyContin coverage under Medicare Part D?

If you’re enrolled in Original Medicare, Part A and Part B, keep in mind that prescription drug coverage for OxyContin is limited. Part A generally covers any medications you need during an inpatient hospital or skilled nursing facility stay, including OxyContin. Part B generally, covers prescription drugs administered to you in an outpatient setting, such as a doctor’s office or clinic. Part B-covered medications tend to be the type that needs to be administered by a doctor, such as infusions or injections, not prescription medications you take orally, like OxyContin.

For all other Medicare prescription drug coverage, including coverage for the prescription drugs such as OxyContin you take at home, you’ll need to enroll in Medicare Part D. You can get Part D coverage through:

  • A stand-alone Medicare Prescription Drug Plan, which works with your Original Medicare coverage.
  • A Medicare Advantage Prescription Drug plan and get your Part A, Part B, and Part D benefits all under a single plan. You still need to keep paying your Part B premium, along with any premium the plan may charge.

Remember, Medicare prescription drug coverage under Part D doesn’t happen automatically when you enroll in Medicare; you need to sign up for it.

All Medicare plans with prescription drug coverage have a formulary, or list of covered drugs. The formulary details which prescription drugs are covered and their costs. So, if you’d like to check whether a specific Medicare plan covers OxyContin, you can look up that information in the plan’s formulary. Keep in mind that a plan’s formulary may change at any time; you’ll be notified by the plan if necessary.

Would you like help finding Medicare plans that cover OxyContin? To set up a phone appointment to discuss your Medicare needs or receive an email with plan information, click the links below. Or, to start browsing now, use the Compare Plans button to find Medicare plan options; you can even enter in your prescriptions to filter your search.

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