| Anthem Blue Cross (HMO, PPO, EPO) |
| Dyanavel XR (amphetamine) |
| Drugs for the Nervous System : Drugs for Attention Deficit Disorder |
- Prior Authorization: PA Required
- Quantity Limit: 3 tablets per 1 day(s).
- Quantity Limit: 30 day supply per 1 fill(s).
- Quantity Limit: 1 capsule per 1 day(s).
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