Vyvanse — CareFirst (Caremark)

Attention Deficit Disorder (ADD)

Initial criteria

For ADHD/ADD: Diagnosis has been appropriately documented (e.g., evaluated by a complete clinical assessment, using DSM-5, standardized rating scales, interviews/questionnaires)
If patient age ≤ 5 years, symptoms persist despite evidence-based behavioral therapy such as parent training in behavior management (PTBM) or behavioral classroom interventions
For Narcolepsy: The request is NOT for amphetamine extended-release (Adzenys ER, Adzenys XR-ODT), amphetamine-dextroamphetamine extended-release (Adderall XR), amphetamine sulfate orally disintegrating tablet (Evekeo ODT), methylphenidate chewable tablet, methylphenidate immediate release, methylphenidate extended-release (Aptensio XR, Concerta, Cotempla XR-ODT, methylphenidate CD, Methylphenidate Osmotic Extended-Release, Relexxii, Ritalin LA), dexmethylphenidate (Focalin), or dexmethylphenidate extended-release (Focalin XR)
The drug is prescribed by or in consultation with a sleep specialist
Diagnosis has been confirmed by a sleep study

For ADHD/ADD: Patient achieved or maintained improvement in their signs and symptoms of ADHD/ADD from baseline AND need for continued therapy has been assessed within the previous year
For Narcolepsy: Request is NOT for excluded formulations listed in initial criteria AND patient has achieved or maintained improvement in daytime sleepiness with narcolepsy from baseline