Amphetamine

10 mg, 12.5 mg, 15 mg, 15.7 mg, 18.8 mg, 2.5 mg/mL, 20 mg, 3.1 mg, 5 mg, 6.3 mg, 9.4 mg — Tablet

Also known as: Amphetamine 5 Mg Tablet Amphetamine 10 Mg Tablet ADZENYS XR-ODT DYANAVEL XR AMPHETAMINE ER ODT amphetamine tbed 3.1mg, 6.3mg, 9.4mg,

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 2 - Preferred Brand	—	—	✓	QL

1 plan

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Dyanavel XR	Non-Preferred	—	—	—	None

9 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL
NC State Health Plan - 80/20 Plus PPO 2026 via Dyanavel XR	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Dyanavel XR	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Dyanavel XR	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Adzenys Xr-Odt	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Adzenys Xr-Odt	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Adzenys Xr-Odt	Not Covered	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	—	None