etripamil

Generic: Cardamyst

70 mg/2 spray — Spray

Also known as: CARDAMYST

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

5 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 21 hours, 45 minutes ago

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

3 plans

Source: CMS QHP JSON · Formulary date: Sep 16, 2026 · Checked: 21 hours, 45 minutes ago

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

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 21 hours, 45 minutes ago

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

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 21 hours, 45 minutes ago

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