dextroamphetamine sulf-saccharate/amphetamine sulf-aspartate

10 mg, 12.5 mg, 15 mg, 20 mg, 25 mg, 30 mg, 37.5 mg, 5 mg, 50 mg — Extended Release Capsule

Also known as: DEXTROAMPHETAMINE-AMPHET ER MYDAYIS

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

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 17 hours, 40 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Basic Core Formulary	✓	—	—	PA