| Anthem Blue Cross (HMO, PPO, EPO) |
| dexmethylphenidate (dexmethylphenidate) |
| Drugs for the Nervous System : Drugs for Attention Deficit Disorder |
- PA Applies
- Prior Authorization: PA_APPLIES
- QL (270 per Rx);
- Subject to initial 7-day limit, if age 19 or younger, subject to initial 3-day limit
|