CommercialPrior AuthMedium impact
Vyvanse (lisdexamfetamine dimesylate)
Blue Cross & Blue Shield of Mississippi·MS · Psychiatry, Pediatrics, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Vyvanse (lisdexamfetamine) prior authorization policy, establishing strict criteria for ADHD patients ages 6-18 and binge eating disorder patients ages 18-65. Prior authorization is required for all Vyvanse prescriptions with specific quantity limits and trial requirements for alternative medications.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for ALL Vyvanse prescriptions before dispensing. Providers must document either: 1) For ADHD patients (6-18 years): inadequate response to at least two different formulary generic extended-release stimulants OR FDA contraindication to all formulary stimulants, 2) For binge eating disorder patients (18-65 years): detailed clinical criteria including binge frequency, symptoms, BMI 25-45, and previous therapy outcomes. Update encounter forms to remind providers of documentation requirements. Claims will be denied without proper prior authorization.