Dexedrine Spansules — Cigna
Attention Deficit Hyperactivity Disorder
Preferred products
- Generic amphetamine/dextroamphetamine extended-release capsules (generic to Adderall XR)
- Generic dexmethylphenidate extended-release capsules (generic to Focalin XR)
- Generic dextroamphetamine extended-release capsules (generic to Dexedrine Spansules)
- Generic lisdexamfetamine capsules
- Generic methylphenidate extended-release capsules (generic to Metadate CD and Ritalin LA)
- Metadate ER (generic according to First Data Bank [FDB])
- Generic methylphenidate sustained-release tablets (generic to Ritalin SR)
- Generic methylphenidate extended-release tablets (generic to Concerta)
- Generic mixed salts of a single-entity amphetamine product extended-release capsules (generic to Mydayis)
Initial criteria
- If the patient has tried one Step 1 Product, approve a Step 2 Product.
Approval duration
1 year