Evekeo

Generic: amphetamine sulfate

5MG, 10MG — Tablet

Also known as: EVEKEO TABS 5MG, 10MG

Coverage by Insurer

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

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 17 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Gold with Atrium Health + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Silver + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Gold + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Complete Gold via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Everyday Bronze via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Elite Bronze via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Clear Silver with $0 Insulin Options via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Expanded Bronze via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Silver via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Gold via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Everyday Bronze with Atrium Health via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Elite Bronze with Atrium Health via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Focused Silver with Atrium Health via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Complete Gold with Atrium Health via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Expanded Bronze with Atrium Health via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Silver with Atrium Health via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Gold with Atrium Health via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Complete Gold + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Elite Bronze + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental via amphetamine sulfate	Tier 4 - Non-Preferred	✓	—	—	PA

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 36 minutes ago

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

NC State Health Plan

6 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 36 minutes ago

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

UnitedHealthcare

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 17 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026 via amphetamine sulfate	Unknown	✓	—	—	PA