STIMULANTS AND RELATED AGENTS | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
ADDERALL XR 25 MG CAPSULE dextroamphetamine/amphetamine	54092038901 TAKEDA PHARMACE	Yes	No	Medicaid CHIP CSHCN
ADDERALL XR 30 MG CAPSULE dextroamphetamine/amphetamine	54092039101 TAKEDA PHARMACE	Yes	No	Medicaid CHIP CSHCN
ADDERALL XR 5 MG CAPSULE dextroamphetamine/amphetamine	54092038101 TAKEDA PHARMACE	Yes	No	Medicaid CHIP CSHCN
ATOMOXETINE HCL 10 MG CAPSULE atomoxetine HCl	55111051930 DR.REDDY'S LAB	Yes	No	Medicaid CHIP CSHCN
ATOMOXETINE HCL 10 MG CAPSULE atomoxetine HCl	35573041530 BUREL PHARMACEU	Yes	No	Medicaid CHIP CSHCN
ATOMOXETINE HCL 10 MG CAPSULE atomoxetine HCl	00093354256 TEVA USA	Yes	No	Medicaid CHIP CSHCN
ATOMOXETINE HCL 10 MG CAPSULE atomoxetine HCl	64980037303 RISING PHARM	Yes	No	Medicaid CHIP CSHCN
ATOMOXETINE HCL 10 MG CAPSULE atomoxetine HCl	31722071430 CAMBER PHARMACE	Yes	No	Medicaid CHIP CSHCN
ATOMOXETINE HCL 10 MG CAPSULE atomoxetine HCl	68462026530 GLENMARK PHARMA	Yes	No	Medicaid CHIP CSHCN
ATOMOXETINE HCL 10 MG CAPSULE atomoxetine HCl	60505283003 APOTEX CORP	Yes	No	Medicaid CHIP CSHCN