disopyramide phosphate

100 mg, 150 mg — Capsule

ANTIARRHYTHMICS

Also known as: disopyramide phosphate caps 100mg, 150mg disopyramide phosphate cap 100 mg, 150 mg Disopyramide Phosphate Oral Capsule
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Checked: 23 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Essential + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Silver Signature + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Gold Signature + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas Next Gold Premier + No Referrals
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 23 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 1 - Generic — — — None
BCBS Federal Focus 2026 Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026 Tier 1 - Generic — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 23 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026
via Norpace Cr 		Tier 3 - High Cost Brand — — — Restricted Access None
BCBSNC Blue Home with UNC Health Alliance 2026
via Norpace Cr 		Tier 3 - High Cost Brand — — — Restricted Access None
BCBSNC Blue Advantage 2026
via Norpace Cr 		Tier 3 - High Cost Brand — — — Restricted Access None
BCBSNC Blue Value 2026
via Norpace Cr 		Tier 3 - High Cost Brand — — — Restricted Access None
BCBSNC Blue Care 2026
via Norpace Cr 		Tier 3 - High Cost Brand — — — Restricted Access None
Source: PDF  ·  Formulary date: Jul 17, 2026  ·  Checked: 23 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD 5000 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Bronze 5500 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Silver 3500 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 3500 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Silver 4400 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Bronze 6500 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Silver
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Bronze
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Gold 1500 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Silver 3000 Indiv Med Deductible
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Gold CMS Standard
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Bronze CMS Standard
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Silver RD CMS Standard
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Silver CMS Standard
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Gold RD CMS Standard
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD CMS Standard
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 23 hours, 2 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Troy Medicare (HMO) Tier 2 - Generic — — — None
Senior Care (HMO I-SNP) Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 2 - Generic — — — None
DEVOTED CHOICE 003 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 005 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 008 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 4 - Non-Preferred — — — None
Wellcare Simple Open (PPO) Tier 4 - Non-Preferred — — — None
Wellcare Simple (HMO-POS) Tier 4 - Non-Preferred — — — None
Wellcare Giveback Open (PPO) Tier 4 - Non-Preferred — — — None
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Dual (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Giveback (PPO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Troy Medicare (HMO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Assist Open (PPO) Tier 4 - Non-Preferred — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred ✓ — — PA
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED CORE 001 NC (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 001 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Extra (PPO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (HMO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Care (HMO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Prime (HMO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Value Plus (HMO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Dual (HMO D-SNP)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature Giveback (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Chronic Care (HMO C-SNP)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Norpace Cr 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature Extra (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred ✓ — — PA
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 23 hours, 2 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic — — — None
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