dextroamphetamine/amphetamine

10 MG, 12.5 MG, 15 MG, 20 MG, 25 MG, 30 MG, 37.5 MG, 5 MG, 50 MG — CPTP 24HR

Also known as: MYDAYIS DEXTROAMPHETAMINE-AMPHET ER 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: Oct 29, 2026 · Checked: 3 hours, 52 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Generic Formulary (Basic Core)	✓	—	—	PA PA on 11 of 133 NDCs: PA DRUGS, DOD PA REQUIRED