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Dextroamphetamine SulfateĀ - Dextroamphetamine SulfateĀ tablet
Prominence Health Plan
Prominence Health Plan Coverage for Dextroamphetamine SulfateĀ - Dextroamphetamine SulfateĀ tablet
All
4
Commercial
3
Medicare
1
Commercial
Commercial - HMO
No PA
No Step Therapy
Quantity Limit
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Commercial - Point of Service
No PA
No Step Therapy
Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
Quantity Limit
See Details
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