Milestone's nasal spray heart drug available via Express Scripts
About 2 million Americans have a heart condition called “paroxysmal supraventricular tachycardia,” or PSVT. An electrical problem in the heart causes it to beat very fast—150-220 beats per minute—versus the normal 60-100 beats.
Some people have only mild symptoms; others experience debilitating dizziness, shortness of breath and chest discomfort. Frustratingly, for people with PSVT, they don’t know when an episode will occur or when it will end. Also, treatment options often work by stopping the heart briefly, then restarting it, with the hope that it will convert to a normal rate and rhythm. They often take place in the emergency department, making them costly and time-consuming.
Milestone Pharmaceuticals (Nasdaq: MIST), based in Montreal with a U.S. subsidiary in Charlotte, seeks to shift PSVT treatment from the medical setting to patients themselves through an innovative nasal spray, CARDAMYST™ (etripamil), approved in December 2025 by the U.S. Food and Drug Administration. Achieving that goal got a major boost recently from Express Scripts, one of the country’s top three pharmacy benefit managers, which has accepted the drug into its commercial formulary.
“This decision by Express Scripts represents the first contracted formulary acceptance of CARDAMYST by a major payor and thereby significantly improves access to this important new treatment option,” said Milestone’s Chief Commercial Officer, Lorenz Muller, in the announcement. “We are committed to making CARDAMYST affordable and accessible to the patient community, and we expect coverage to ramp up as we continue to engage with other insurance providers.”
In the announcement, Milestone noted how difficult the uncertainty of PVST is for people, often negatively affecting their daily lives. Being able to self-administer the nasal spray would make an enormous difference to many.
“The impact and morbidity from an attack can be especially detrimental in patients with underlying cardiovascular or medical conditions, such as heart failure, obstructive coronary disease, or dehydration,” the company added. “Many health care providers are dissatisfied with the lack of effective treatment options, with patients often electing to pursue prolonged, burdensome, and costly trips to the emergency department.”
“This is an exciting opportunity for Milestone Pharmaceuticals and reflects ongoing growth of biopharma and other life sciences companies in the larger Charlotte area,” said Corie Curtis, executive director of the Greater Charlotte Region office of the North Carolina Biotechnology Center. “Our region had a strong year in 2025, and we look forward to more announcements in 2026.”
The FDA approved CARDAMYST nasal spray for the conversion of acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm in adults. For more information about the company, PVST, drug side effects and contraindications, please see the company’s announcement.