Anthem Blue Cross (HMO, PPO, EPO)
Dyanavel XR (amphetamine)
Drugs for the Nervous System : Drugs for Attention Deficit Disorder
  • ADHD:
    Age Requirement: >= 6
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Quantity Limit: limit maximum 8 mL PER 1 day(s)
  • Step Therapy: ADHD:
    ST Single Generic

  • Prior Authorization: ADHD:
    Documented Diagnosis: Yes
    Age Requirement: >= 6
    Duration: 1 year(s)