risdiplam

Generic: Evrysdi

5 mg — Tablet

NEUROLOGICAL AGENTS MISCELLANEOUS

Also known as: EVRYSDI
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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: 14 hours, 34 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Signature + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 14 hours, 34 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Home with UNC Health Alliance 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 Local 2026
via Evrysdi 		Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
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
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 14 hours, 34 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NHC Advantage (HMO I-SNP)
via Evrysdi 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Liberty Medicare Dual Plan (HMO D-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
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 Advantage Nursing Home Plan (HMO I-SNP)
via Evrysdi 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Evrysdi 		Tier 5 - Specialty ✓ — — PA
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
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Evrysdi 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Senior Care (HMO I-SNP)
via Evrysdi 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 14 hours, 34 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary ✓ — — PA
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