Oxford Health Plans > Prescription Drug List

Prescription Drug List

The Prescription Drug List (PDL) outlines covered medications and organizes them into cost levels, also known as tiers. It includes both brand-name and generic prescription medications approved by the Food and Drug Administration (FDA).


The PDL may not be a complete list of medications, and not all medications listed may be covered under every plan. Please review your client’s benefit plan documents to see which medications are covered under their plan. For specific information about a member's benefits, the member should refer to their Certificate of Coverage and/or Summary of Benefits.


If you have any questions about a PDL, please call Client Services at 1-888-201-4216.


PDLs are accurate at the time they are released and are subject to change after that date.



January 1, 2018 PDLs

Access Three-Tier (New York and New Jersey)
Access Three-Tier Updates Summary Flier

Advantage Three-Tier (New York and New Jersey Small Group)
Advantage Three-Tier Updates Summary Flier

Enhanced Traditional Three-Tier (New York and New Jersey)
Enhanced Traditional Three-Tier Updates Summary Flier



July 1, 2017 PDLs

Advantage Three-Tier (Connecticut)
Advantage Three-Tier Updates Summary Flier

Advantage Three-Tier (New York and New Jersey)
Advantage Three-Tier Updates Summary Flier

Traditional Three-Tier (Connecticut)
Traditional Three-Tier Updates Summary Flier

Traditional Three-Tier (New York and New Jersey)
Traditional Three-Tier Updates Summary Flier

Four-Tier (Connecticut)




More Information

  • Getting to Know Your PDL

  • Certain prescription medications may require precertification.

  • For most New York (NY) and Connecticut (CT) employer groups, diabetic supplies, including oral prescription medications, will be subject to the applicable medical office visit cost-share noted on the member's Summary of Benefits.

  • For most New Jersey (NJ) employer groups that have purchased coverage for outpatient prescription drugs, diabetic prescription medications will be subject to the applicable prescription benefit cost-share noted on the member's Summary of Benefits. For NJ employer groups that have not purchased coverage for outpatient prescription drugs, diabetic supplies will be subject to the applicable medical office visit cost-share noted on the member's Summary of Benefits.

  • The copayment (cost-share) for the medications on this list may vary by dosage form and strength.


    Locate a pharmacy
    Visit optumrx.com

    Note: To assist our providers, the medications on this Prescription Drug List (PDL) have been listed by both their generic name and brand name. The presence of a medication on this list does not guarantee that a generic version is available.