| 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)
- Prior Authorization: ADHD:
Documented Diagnosis: Yes
Age Requirement: >= 6
Duration: 1 year(s)
- Step Therapy: ADHD:
ST Single Generic
|