Vyvanse

Generic: Lisdexamfetamine

10MG, 20MG, 30MG, 40MG, 50MG, 60MG, 70MG — Capsule

Antihyperkinesis / Adhd

Also known as: VYVANSE CAPS 10MG, 20MG, 30MG, 40MG, 50MG, 60MG, 70MG; CHEW 10MG, 20MG, 30MG, 40MG, 50MG, 60MG VYVANSE CAPS 10MG, 20MG, 30MG, 40MG, Vyvanse 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.
Source: CMS QHP JSON  ·  Checked: 17 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 4 - Non-Preferred — ✓ ✓ ST | QL
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 4 - Non-Preferred — ✓ ✓ ST | QL
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 4 - Non-Preferred — ✓ ✓ ST | QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 4 - Non-Preferred — ✓ ✓ ST | QL
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 4 - Non-Preferred — ✓ ✓ ST | QL
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 4 - Non-Preferred — ✓ ✓ ST | QL
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 3 - Non-Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026 Tier 3 - Non-Preferred Brand ✓ — — PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Local 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Advantage 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Care 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 7000 HSA Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Silver 4400 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Silver RD 5000 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Silver 3000 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Bronze 6500 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Gold RD CMS Standard
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Silver CMS Standard
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Bronze RD CMS Standard
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Gold CMS Standard
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Silver RD CMS Standard
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Bronze CMS Standard
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect myDiabetesCare Silver
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Silver RD 2200 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Gold 1500 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect myDiabetesCare Bronze
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Bronze 5500 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Bronze RD 6000 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Silver 3500 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Bronze RD 5000 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Connect Silver RD 3500 Indiv Med Deductible
via Lisdexamfetamine 		Tier 2 - Generic ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 17 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Aetna Medicare Signature (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Value Plus (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Prime (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature Care (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Enhanced (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Enhanced (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Enhanced (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature Extra (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature Giveback (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthSpring True Choice (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthSpring TotalCare (HMO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthSpring TotalCare Plus (HMO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthSpring Preferred (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthSpring Preferred Select (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthSpring Preferred Savings (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthSpring Preferred Plus (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred ✓ — ✓ 30 per 30 days PA | QL
DEVOTED DUAL 009 NC (HMO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred ✓ — ✓ 30 per 30 days PA | QL
DEVOTED CORE 001 NC (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred ✓ — ✓ 30 per 30 days PA | QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred ✓ — ✓ 30 per 30 days PA | QL
Wellcare Simple Open (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Simple (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Giveback Open (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Assist Open (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
DEVOTED GIVEBACK 002 NC (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-S001 (PPO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Signature (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Freedom (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Liberty (HMO-POS)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Dual (HMO D-SNP)
via Lisdexamfetamine 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Lisdexamfetamine 		Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 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
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