| Anthem Blue Cross (HMO, PPO, EPO) |
| Adzenys ER (amphetamine) |
| 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)
- 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 15 mL PER 1 day(s)
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