Amphetamine

Generic: Adzenys

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 tbed 3.1mg, 6.3mg, 9.4mg, 12.5mg, 15.7mg, 18.8mg Amphetamine 5 Mg Tablet Amphetamine 10 Mg Tablet ADZENYS XR-ODT DYANAVEL XR AMPHETAMINE ER ODT amphetamine tbed 3.1mg, 6.3mg, 9.4mg, Amphetamine ER Oral Tablet Extended Release Disintegrating

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Coverage by Insurer

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

AmeriHealth Caritas NC

30 plans

Source: CMS QHP JSON · Checked: 15 hours, 23 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Essential + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Premier + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Signature + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Signature + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Essential + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Premier + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Premier + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Essential + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Signature + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Premier + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Essential + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Signature + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Signature + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Signature + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Premier + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Premier + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL

Medicare Part D

1 plan

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 15 hours, 23 minutes ago

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

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 23 minutes ago

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

NC State Health Plan

9 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 23 minutes ago

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

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jun 24, 2026 · Checked: 15 hours, 23 minutes ago

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