risdiplam

Generic: Evrysdi

5 mg — Tablet

Also known as: EVRYSDI

Coverage by Insurer

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

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 9 hours, 33 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Care 2026 via Evrysdi	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Value 2026 via Evrysdi	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Advantage 2026 via Evrysdi	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026 via Evrysdi	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Local 2026 via Evrysdi	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL

Medicare Part D

16 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 9 hours, 33 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) via Evrysdi	Tier 1 - Preferred Generic	✓	—	✓ 30 per 30 days	PA \| QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP) via Evrysdi	Tier 1 - Preferred Generic	✓	—	✓ 240 per 30 days	PA \| QL
Provider Partners North Carolina Community Plan (HMO I-SNP) via Evrysdi	Tier 1 - Preferred Generic	✓	—	✓ 240 per 30 days	PA \| QL
Provider Partners North Carolina Essential Plan (HMO I-SNP) via Evrysdi	Tier 1 - Preferred Generic	✓	—	✓ 240 per 30 days	PA \| QL
Liberty Medicare Dual Plan (HMO D-SNP) via Evrysdi	Tier 1 - Preferred Generic	✓	—	✓ 30 per 30 days	PA \| QL
NHC Advantage (HMO I-SNP) via Evrysdi	Tier 1 - Preferred Generic	✓	—	✓ 30 per 30 days	PA \| QL
PruittHealth Premier (HMO I-SNP) via Evrysdi	Tier 1 - Preferred Generic	✓	—	✓ 30 per 30 days	PA \| QL
Senior Care (HMO I-SNP) via Evrysdi	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
Liberty Medicare Advantage (HMO C-SNP) via Evrysdi	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
HealthTeam Advantage Plan I (PPO) via Evrysdi	Tier 5 - Specialty	✓	—	✓ 240 per 30 days	PA \| QL
HealthTeam Advantage Plan II (PPO) via Evrysdi	Tier 5 - Specialty	✓	—	✓ 240 per 30 days	PA \| QL
HealthTeam Advantage Vitality Plan (PPO) via Evrysdi	Tier 5 - Specialty	✓	—	✓ 240 per 30 days	PA \| QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) via Evrysdi	Tier 5 - Specialty	✓	—	✓ 240 per 30 days	PA \| QL
Troy Medicare (HMO) via Evrysdi	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Evrysdi	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas VIP Care (HMO D-SNP) via Evrysdi	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 9 hours, 33 minutes ago

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