Dyanavel XR

Generic: Amphetamine

2.5MG — Tablet

Also known as: DYANAVEL XR SUER 2.5MG/ML; TBCR 5MG, 10MG, 15MG, 20MG DYANAVEL XR SUER 2.5MG/ML; TBCR 5MG,

Coverage by Insurer

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

AmeriHealth Caritas NC

31 plans

Source: CMS QHP JSON · Formulary date: Sep 22, 2026 · Checked: 7 hours, 54 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Premier + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 1 - Preferred Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Amphetamine	Tier 2 - Generic	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + 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
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Adzenys Xr-Odt	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + 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

Medicare Part D

1 plan

Source: CMS QHP JSON · Formulary date: Sep 16, 2026 · Checked: 7 hours, 54 minutes ago

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

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 7 hours, 54 minutes ago

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

NC State Health Plan

9 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 7 hours, 54 minutes ago

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

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 7 hours, 53 minutes ago

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