Drug Coverage Lookup

See how a prescription drug is placed across Medicare Part D plan formularies — tier, prior authorization, step therapy, and quantity limits, counted per unique plan.

Cardamyst (Etripamil)

On Part D plan formularies — with restrictions

Found on the formularies of 37 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 37 plans (100%) · quantity limits on 37 (100%), counting a plan when at least one form/strength carries the flag.

This is dataset-wide formulary placement (data current through 2026-08-31) — check your specific plan for its current coverage and restrictions.

Found on the formularies of 37 of 5499 Medicare Part D plans in this dataset, but prior authorization appears on 37 of those 37 plans (for at least one form/strength). Check your specific plan for its current rules, and learn what your prescriber needs to submit.
How prior authorization works →
PlanTierPrior AuthStep TherapyQty Limit
Alameda Alliance Wellness (HMO D-SNP) (H2035-001) (CA) Tier 1 Yes No 4 per 30 days
SeniorCare Complete (HMO D-SNP) (H2419-001) (MN) Tier 1 Yes No 4 per 30 days
AbilityCare (HMO D-SNP) (H5703-001) (MN) Tier 1 Yes No 4 per 30 days
NaviCare (HMO D-SNP) (H8928-001) (MA) Tier 1 Yes No 4 per 30 days
CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) Tier 2 Yes No 2 per 28 days
CareOregon Advantage Plus (HMO D-SNP) (H5859-001) (OR) Tier 4 Yes No 2 per 30 days
AmeriHealth Caritas VIP Care (HMO D-SNP) (H0738-001) (DE) Tier 5 Yes No 4 per 30 days
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) (H0738-002) (DE) Tier 5 Yes No 4 per 30 days
AmeriHealth Caritas VIP Care (HMO D-SNP) (H2564-001) (LA) Tier 5 Yes No 4 per 30 days
Geisinger Gold Preferred Complete Rx (PPO) (H3924-065) (PA) Tier 5 Yes No 2 per 28 days
Geisinger Gold Secure Rx (HMO D-SNP) (H3954-097) (PA) Tier 5 Yes No 2 per 28 days
Geisinger Gold Classic 360 Rx (HMO) (H3954-160) (PA) Tier 5 Yes No 2 per 28 days
Geisinger Gold Classic Essential Rx (HMO) (H3954-161) (PA) Tier 5 Yes No 2 per 28 days
Keystone First VIP Choice (HMO D-SNP) (H4227-001) (PA) Tier 5 Yes No 4 per 30 days
AmeriHealth Caritas VIP Care (HMO D-SNP) (H4227-002) (PA) Tier 5 Yes No 4 per 30 days
Troy Medicare (HMO) (H4676-001) (NC) Tier 5 Yes No 4 per 30 days
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) (H4676-002) (NC) Tier 5 Yes No 4 per 30 days
First Choice VIP Care (HMO D-SNP) (H4739-001) (SC) Tier 5 Yes No 4 per 30 days
Contra Costa Health Care Plus (HMO D-SNP) (H5119-001) (CA) Tier 5 Yes No 4 per 30 days
AmeriHealth Caritas VIP Care (HMO D-SNP) (H6341-001) (MI) Tier 5 Yes No 4 per 30 days
AmeriHealth Caritas VIP Care (HMO D-SNP) (H6378-001) (FL) Tier 5 Yes No 4 per 30 days
AmeriHealth Caritas VIP Care (HMO D-SNP) (H8212-001) (NC) Tier 5 Yes No 4 per 30 days
Fallon Medicare Plus Orange (HMO) (H9001-038) (MA) Tier 5 Yes No 4 per 30 days
Geisinger Gold Value Rx (HMO) (H3954-163) (PA) Tier 5 Yes No 2 per 28 days
Geisinger Gold Classic Complete Rx (HMO) (H3954-158) (segment 13) (PA) Tier 5 Yes No 2 per 28 days

One row per plan — showing 25 of 37 plans; a Yes means the flag applies to at least one form/strength on that plan.

For benefits professionals
Plan sponsors and advisors: formulary-placement and utilization analysis across plans.
For benefits teams: plan formulary analysis →

Source: CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — data current through 2026-08-31 (CMS release 2026-08-26, refreshed monthly). Dataset-wide plan-year formulary placement, not a guarantee of your individual benefit — confirm with your plan or pharmacist.

Data: CMS Monthly Part D formulary files · FDA/RxNorm drug identity · CMS NADAC pricing — CMS Part D formulary data current through 2026-08-31 · source

Machine access — this tool is available as structured data for AI assistants and agents:
GET https://insurewith.ai/tools/drug-coverage/data.json?drug=etripamil
InsureWith Assistant
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