Cardamyst

Generic: etripamil

70MG/2SPRY — Nasal Spray

Also known as: etripamil

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

5 plans

Source: PDF · Formulary date: Nov 1, 2026 · Checked: 5 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Advantage 2026	Tier 4 - Higher Cost Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 4 - Higher Cost Brand	—	—	—	None
BCBSNC Blue Local 2026	Tier 4 - Higher Cost Brand	—	—	—	None
BCBSNC Blue Care 2026	Tier 4 - Higher Cost Brand	—	—	—	None
BCBSNC Blue Value 2026	Tier 4 - Higher Cost Brand	—	—	—	None

3 plans

Source: CMS QHP JSON · Formulary date: Sep 16, 2026 · Checked: 5 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 30 days	PA \| QL
Troy Medicare (HMO)	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: PDF · Formulary date: Oct 1, 2026 · Checked: 5 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Oct 29, 2026 · Checked: 5 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	✓ CARDAMYST TO BE DISPENSED AT A MAXIMUM QUANTITY OF 4 BOTTLES (2 CARTONS) IN 23 DAYS	PA \| QL PA: TPA - SELECT DRUGS REQUIRES PRIOR AUTHORIZATION (NEW TO MARKET DRUGS); Quantity limit