Cardamyst

Generic: etripamil

35 MG — Nasal Spray

Also known as: etripamil

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

3 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 3 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Troy Medicare (HMO)	Tier 5 - Specialty	✓	—	✓ 4 per 30 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 30 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 30 days	PA \| QL

1 plan

Source: Excel (XLSX) · Formulary date: May 29, 2026 · Checked: 3 hours, 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via etripamil	Tier 3 - Non-Formulary	—	—	—	None