| Anthem Blue Cross (HMO, PPO, EPO) |
| ProCentra (dextroamphetamine sulfate) |
| Drugs for the Nervous System : Drugs for Attention Deficit Disorder |
- PA Applies
- Prior Authorization: PA Applies
- Quantity Limit: limit maximum 60 mL PER 1 day(s)
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
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