lisdexamfetamine dimesylate
10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg — Capsule
ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ ANOREXIANTS
Also known as:
lisdexamfetamine dimesylate caps 10mg, 20mg, 30mg, 40mg, 50mg, 60mg, 70mg; chew 10mg, 20mg, 30mg, 40mg, 50mg, 60mg
lisdexamfetamine dimesylate cap 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg
lisdexamfetamine dimesylate caps 10mg,
ARYNTA
Lisdexamfetamine Dimesylate Oral Capsule
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Elite Bronze | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Silver + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Gold + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Everyday Bronze | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Expanded Bronze | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Silver | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Complete Gold | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Gold | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Expanded Bronze with Atrium Health | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Silver with Atrium Health | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Signature Gold with Atrium Health | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Clear Silver with $0 Insulin Options + Vision + Adult Dental | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Streamlined Silver | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Streamlined Silver with Atrium Health | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options | Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
AmeriHealth Caritas NC
11 plans| 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 | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 1 - Generic | ✓ | — | — | PA |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | ✓ | — | — | PA |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | ✓ | — | — | PA |
Medicare Part D
83 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| Senior Care (HMO I-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | ✓ 30 per 30 days | PA | QL |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | ✓ 30 per 30 days | PA | QL |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 30 per 30 days | PA | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Erickson Advantage Freedom (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Erickson Advantage Liberty (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| HealthSpring TotalCare (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| HealthSpring Preferred (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| HealthSpring Preferred Select (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| HealthSpring Preferred Savings (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| HealthSpring Preferred Plus (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Erickson Advantage Signature (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Wellcare Assist Open (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Wellcare Giveback Open (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Value Plus (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Prime (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare PPO Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare Choice (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare Essential (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Experience Health Medicare Advantage (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Wellcare Simple (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 30 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CORE 001 NC (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 30 per 30 days | PA | QL |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 30 per 30 days | PA | QL |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 2 - Non-Preferred Generic | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 2 - Non-Preferred Generic | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 2 - Non-Preferred Generic | ✓ | — | ✓ | PA | QL |
TRICARE
1 planUnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Standard (HSA, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |