Qelbree (viloxazine) — United Healthcare

attention deficit hyperactivity disorder (ADHD)

Preferred products

methylphenidate class stimulant (e.g. generic Concerta)
amphetamine class stimulant (e.g. generic Adderall XR)
alpha-2 adrenergic agonist [e.g. clonidine extended-release, guanfacine extended-release]
atomoxetine (generic Strattera)
Onyda XR

One of the following: (1) History of failure, contraindication, or intolerance to both of the following (document medication names and dates of trials): (a) a methylphenidate class stimulant (e.g. generic Concerta) AND (b) an amphetamine class stimulant (e.g. generic Adderall XR) OR (2) History of a substance use disorder or concern for potential misuse and/or diversion
AND one of the following: (1) History of failure, contraindication, or intolerance to both of the following: (a) an alpha-2 adrenergic agonist [e.g. clonidine extended-release, guanfacine extended-release (document medication name and date of trial)] AND (b) atomoxetine [(generic Strattera) document date of trial] OR (2) Both of the following: (a) Patient is unable to swallow a solid dosage form (i.e. an oral tablet or capsule) due to age, oral/motor difficulties, or dysphagia AND (b) History of failure, contraindication, or intolerance to Onyda XR (document date of trial)

12 months