| Anthem Blue Cross (HMO, PPO, EPO) |
| dextroamphetamine sulfate (dextroamphetamine sulfate) |
| Drugs for the Nervous System : Drugs for Attention Deficit Disorder |
- Preventive Drug: Zero copay.
- Prior Authorization: Migraine:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 Month(s)
Reauthorization Required: Yes
Migraine Prevention:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 Month(s)
- Prior Authorization: PA_APPLIES
- 1; User Field 13;
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