Intuniv — Cigna
Attention Deficit Hyperactivity Disorder (ADHD)
Preferred products
- generic atomoxetine capsules
- amphetamine sulfate tablets (Evekeo™)
- amphetamine extended-release orally disintegrating tablets (Adzenys XR-ODT™)
- amphetamine extended-release oral suspension (Dyanavel® XR, Adzenys ER®)
- mixed amphetamine salts immediate-release tablets (Adderall®, generic)
- mixed amphetamine salts extended-release capsules (Adderall XR®, generic)
- dextroamphetamine immediate release tablets (Dexedrine®, Zenzedi®, generic)
- dextroamphetamine sustained-release capsules (Dexedrine® Spansules®, generic)
- dextroamphetamine sulfate oral solution (ProCentra®, generic)
- methamphetamine tablets (Desoxyn®, generic)
- lisdexamfetamine capsules and chewable tablets (Vyvanse®, generic)
- methylphenidate extended-release tablets or capsules (Adhansia XR®, Aptensio XR®, Concerta®, Metadate® CD, Metadate® ER, Ritalin® LA, Ritalin-SR®, generic)
- methylphenidate immediate release tablets, oral solution, and chewable tablets (Ritalin®, Methylin®, Methylin® Chewable, generic)
- dexmethylphenidate immediate-release tablets (Focalin®, generic)
- dexmethylphenidate extended-release capsules (Focalin XR®, generic)
- methylphenidate transdermal system (Daytrana®)
- methylphenidate extended-release oral suspension (Quillivant® XR, QuilliChew ER®)
Initial criteria
- If the patient has tried one Step 1 Product, approve a Step 2 Product.
- OR If the patient is unable to take a stimulant medication AND unable to swallow whole capsules and tablets according to the prescriber, approve Qelbree or Onyda XR.
Approval duration
1 year