dextroamphetamine/amphetamine

12.5 MG, 25 MG, 37.5 MG, 50 MG — CPTP 24HR

Also known as: MYDAYIS DEXTROAMPHETAMINE-AMPHET ER

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: Jul 31, 2026 · Checked: 2 hours, 5 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA