Oxford Health Plans > Prescription Drug List

Prescription Drug List

Our Prescription Drug List (PDL) contains prescription medications that may be covered under our outpatient prescription drug benefit.


Getting to Know Your Prescription Drug List (PDL)

July 2015 Adjustments - Advantage Prescription Drug List (PDL) for members in New York and New Jersey

July 2015 Adjustments - Traditional Prescription Drug List (PDL) for members in New York and New Jersey

July 2015 Advantage Prescription Drug List (PDL) for members in New York and New Jersey (Most members with 3-tier Rx plans)

January 2015 Advantage Prescription Drug List (PDL) for members in Connecticut Only (Most members with 3-tier Rx plans)

July 2015 Traditional Prescription Drug List (PDL) for members in New York and New Jersey

January 2015 Traditional Prescription Drug List (PDL) for members in Connecticut Only

Preventive Care Medications

The Ancillary Charge Program for Connecticut and New York Oxford Plan Members

Please note that the listing of a medication on our Prescription Drug List (PDL) does not guarantee coverage as certain medications are excluded due to benefit plan design limitations specific to members’ individual or group benefits.

The Prescription Drug List is current at the time of release and is subject to change.

  • Prescription medication coverage varies dependent on a member's plan. The fact that a medication is listed on the PDL does not guarantee coverage. For specific information regarding a member's benefits, please refer to the Certificate of Coverage and Summary of Benefits.
  • Please note that certain prescription medications 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.
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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.