arimoclomol citrate

124 mg, 47 mg, 62 mg, 93 mg — Capsule

Also known as: MIPLYFFA

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 4 hours, 54 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026 via Miplyffa	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026 via Miplyffa	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 4 hours, 54 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA