Anthem Blue Cross (HMO, PPO, EPO)
Evekeo ODT (amphetamine sulfate)
Drugs for the Nervous System : Drugs for Attention Deficit Disorder
  • Step Therapy: ADHD:
    ST Single Generic

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

  • Quantity Limit: 2 tablets per 1 day(s).
  • ADHD:
    Age Requirement: >= 6
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

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