Express Scripts Formulary Inclusion Boosts Milestone's CARDAMYST Access
Event summary
- Milestone Pharmaceuticals’ CARDAMYST (etripamil) nasal spray has been added to Express Scripts’ commercial national formularies, effective March 27, 2026.
- CARDAMYST is the first FDA-approved nasal spray for self-administered conversion of acute symptomatic paroxysmal supraventricular tachycardia (PSVT).
- The inclusion represents the first contracted formulary acceptance for CARDAMYST by a major payer.
- CARDAMYST is indicated for adults experiencing acute symptomatic PSVT episodes, a condition affecting approximately 2 million people in the U.S.
The big picture
This formulary inclusion is a critical milestone for Milestone, marking the first major payer acceptance of CARDAMYST and significantly expanding patient access. The drug addresses a clear unmet need for a self-administered PSVT treatment, potentially reducing reliance on emergency room visits and invasive procedures. However, success hinges on Milestone’s ability to manage manufacturing costs and negotiate favorable reimbursement rates with other payers to ensure affordability and sustained market adoption.
What we're watching
- Payer Adoption
- The speed at which other major insurance providers adopt CARDAMYST will be a key indicator of the drug’s overall commercial success and Milestone’s negotiating leverage.
- Market Penetration
- How effectively Milestone can drive awareness and utilization of CARDAMYST among cardiologists and patients will determine if the drug can capture a meaningful share of the PSVT treatment market.
- Clinical Expansion
- The progress of etripamil's Phase 2 pediatric and Phase 3 AFib-RVR trials will influence Milestone’s long-term pipeline value and potential for broader market applications.
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