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.



Jan. 2020 Oxford New York & New Jersey Advantage and Essential PDL PPACA $0 Cost-share Preventive Medications

Jan. 2020 Oxford Connecticut Advantage and Essential PDL PPACA $0 Cost-share Preventive Medications

July 2019 Oxford Traditional Access and Enhanced PDL PPACA $0 Cost-share Preventive Medications

July 2019 Oxford Connecticut Traditional Access and Enhanced PDL PPACA $0 Cost-share Preventive Medications

July 2019 Oxford Advantage and Essential PDL PPACA $0 Cost-share Preventive Medications

July 2019 Oxford Connecticut Advantage and Essential PDL PPACA $0 Cost-share Preventive Medications



January 1, 2020 PDLs

January 2020 Oxford New York/New Jersey Access Three-Tier
Access Three-Tier Updates Summary Flier

January 2020 Oxford New York/New Jersey Access 4-Tier PDL

January 2020 Oxford New York/New Jersey Advantage Three-Tier
Advantage Three-Tier Updates Summary Flier

January 2020 Oxford New York/New Jersey Advantage 4-Tier PDL

January 2020 Oxford New York/New Jersey Traditional 3-Tier PDL

January 2020 Oxford New York/New Jersey Flex Advantage 3-Tier PDL(

January 2020 Oxford New York/New Jersey Flex Base 3-Tier PDL

January 2020 Oxford New York/New Jersey Flex Standard 3-Tier PDL

January 2020 Oxford New York/New Jersey Flex Plus 3-Tier PDL


January 1, 2020 PDLs

Access Three-Tier (Connecticut)

Advantage Three-Tier (Connecticut)

Advantage Four-Tier (Connecticut)

Traditional Three-Tier (Connecticut)



2019 Preventive Drug Lists

Core List for New York Members of an Oxford Consumer Driven Health Plan
Core Plus List for New Jersey Members of an Oxford Consumer Driven Health Plan


July 1, 2019 PDLs

July 2019 Oxford New York/New Jersey Access 3-Tier Traditional PDL

July 2019 Oxford New York/New Jersey Access 4-Tier Traditional PDL

July 2019 Oxford New York/New Jersey Advantage 3-Tier PDL

July 2019 Oxford New York/New Jersey Advantage 4-Tier PDL

July 2019 Oxford New York/New Jersey Flex Advantage 3-Tier PDL

July 2019 Oxford New York/New Jersey Flex Base 3-Tier PDL

July 2019 Oxford New York/New Jersey Flex Plus 3-Tier PDL

July 2019 Oxford New York/New Jersey Flex Standard 3-Tier PDL

July 2019 Oxford New York/New Jersey Traditional 3-Tier PDL


July 2019 CT Access 3-Tier PDL

July 2019 Oxford CT Advantage 3-Tier PDL

July 2019 Oxford CT Advantage 4-Tier PDL

July 2019 Oxford CT Traditional 3-Tier PDL





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.