amphetamine sulfate

5mg, 10mg — Tablet

Amphetamines

Also known as: Evekeo amphetamine sulfate tabs 5mg, 10mg Amphetamine Sulfate Oral Tablet
GoodRx Compare Prices

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 23 hours, 2 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Focused Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze Tier 4 - Non-Preferred ✓ — — PA
Clear Silver with $0 Insulin Options Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze Tier 4 - Non-Preferred ✓ — — PA
Standard Silver Tier 4 - Non-Preferred ✓ — — PA
Standard Gold Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Silver + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Gold with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Complete Gold Tier 4 - Non-Preferred ✓ — — PA
Source: CMS QHP JSON  ·  Checked: 23 hours, 2 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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 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 Silver Essential + No Referrals Tier 2 - Generic — ✓ ✓ ST | QL
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 2 - Generic — ✓ ✓ ST | QL
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
Source: PDF  ·  Formulary date: Jul 17, 2026  ·  Checked: 23 hours, 2 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 4400 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 23 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 23 hours 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 - 80/20 Plus PPO 2026
via Evekeo 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Evekeo 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Evekeo 		Not Covered — — — None
Source: CMS QHP JSON  ·  Checked: 23 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Silver Classic | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health Tier 2 - Generic — — — None
Secure | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes Tier 2 - Generic — — — None
Gold Elite Saver Plus Tier 2 - Generic — — — None
Secure Tier 2 - Generic — — — None
Silver Classic Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic Standard Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Gold Classic Standard Tier 2 - Generic — — — None
Silver Classic Standard Tier 2 - Generic — — — None
Silver Simple PCP Saver Tier 2 - Generic — — — None
Bronze Classic 4700 Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health Tier 2 - Generic — — — None
AIAN Cost Share Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 23 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Standard (No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred ✓ — — PA
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred ✓ — — PA
Something not right?