Parkinson's Medication Cost Catalogue: Cash Price, CMS NADAC & Part D Formulary
Every major Parkinson's medication — from $6.62/month generic Carbidopa/Levodopa to extended-release Rytary, transdermal Neupro, Xadago, Gocovri, Duopa (J7340), Vyalev, Apokyn, Nourianz, and Nuplazid — with official CMS NADAC (2026-10-28) baselines, CY 2026 Medicare Part D formulary status ($2,100 cap), and commercial payer prior-auth rules.
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All 14 Parkinson's Medications: Cash vs. CMS NADAC vs. Medicare Part D
| Medication & Class | What It's For (Sourced) | 30-Day Cash Range | CMS NADAC Baseline (2026-10-28) | Medicare Part D Status (2026) | Prior Auth / Step Therapy | Details |
|---|---|---|---|---|---|---|
| Carbidopa / Levodopa Immediate & Extended Release (Sinemet / Generic) Dopamine Precursor + Decarboxylase Inhibitor (Gold-Standard First-Line Motor Therapy) NDC: 50228045805 (IR 25-100mg) / 72888015501 (ER 25-100mg) | First-line dopamine replacement therapy that crosses the blood-brain barrier to relieve bradykinesia (slowness), rigidity, and resting tremor in Parkinson's disease. Source: NINDS Parkinson's Disease Information Page & FDA Prescribing Information | $14 – $48 / 30 days (90 tablets retail self-pay / discount card); $65 – $140 full retail list (U&C) 25 mg/100 mg tablet, 1 tablet 3 times daily (90 tablets / 30-day supply) | NADAC Published $6.62 / 90 IR tablets • $9.92 / 90 ER tablets ($0.07361 / tablet (IR) • $0.11027 / tablet (ER)) As of 2026-10-28 | Tier 1 (Preferred Generic) or Tier 2 (Generic) $0 – $10 copay per 30-day fill | No Prior Auth (Generic) No (for generic IR and generic ER tablets) | Drug Guide |
| Rytary (Carbidopa / Levodopa Extended-Release Capsules) Dual-Release Microbead Dopamine Precursor (Motor Fluctuations / Wearing-Off) NDC: 64896066101 (23.75-95mg) / 64896066201 (36.25-145mg) / 64896066401 (61.25-245mg) | Extended-release capsule combining immediate- and delayed-release carbidopa/levodopa beads to reduce daily 'OFF' time in patients with motor fluctuations. Source: FDA Prescribing Information (NDA 203312) & Parkinson's Foundation Medications Guide | $410 – $1,350 / 30 days (90–270 capsules depending on daily capsule count) 36.25 mg/145 mg or 61.25 mg/245 mg capsules, 3 capsules 3 times daily (90–270 capsules / 30-day supply) | NADAC Published $357.42 – $449.68 per 90 capsules ($1,072 – $1,349 for 270 capsules/30 days) ($3.97137 – $4.99647 / capsule (Brand) • $3.18395 – $3.94968 / capsule (Corresponding Generic)) As of 2026-10-28 | Tier 4 (Non-Preferred Brand) or Tier 3 (Preferred Brand); Generic ER capsules on Tier 3/4 25%–45% coinsurance or $47–$100 copay until reaching the $2,100 annual Part D out-of-pocket cap ($0 thereafter) | Prior Auth Required Yes — requires documented wearing-off / motor fluctuations despite generic carbidopa/levodopa IR and ER tablets | Drug Guide |
| Pramipexole (Mirapex / Generic IR & ER) Non-Ergot Dopamine Agonist NDC: 68462033290 (0.5mg) / 13668018490 (0.75mg) | Directly stimulates striatal dopamine receptors (D2/D3) as monotherapy in early Parkinson's or as an adjunct to levodopa in advanced disease. Source: NINDS & FDA Prescribing Information | $12 – $38 / 30 days (90 generic IR tablets); $95 – $240 / 30 days (generic ER) 0.5 mg or 0.75 mg tablet, 1 tablet 3 times daily (90 tablets / 30-day supply) | NADAC Published $4.95 – $5.85 / 90 tablets (30-day supply) ($0.05497 – $0.06502 / tablet) As of 2026-10-28 | Tier 1/2 (Generic IR); Tier 3/4 (Extended-Release ER) $0 – $12 copay / 30 days (IR) | No Prior Auth (Generic) No for generic IR; occasional Step Therapy for ER tablets | Drug Guide |
| Ropinirole (Requip / Generic IR & XL) Non-Ergot Dopamine Agonist NDC: 69452035820 (1mg) / 43547027150 (2mg) | Oral dopamine receptor agonist used alone in early Parkinson's disease or alongside carbidopa/levodopa to smooth motor fluctuations. Source: NINDS & FDA Prescribing Information | $11 – $35 / 30 days (90 generic IR tablets); $45 – $130 / 30 days (generic ER/XL) 1 mg or 2 mg tablet, 1 tablet 3 times daily (90 tablets / 30-day supply) | NADAC Published $4.15 – $5.68 / 90 tablets (30-day supply) ($0.04613 – $0.06311 / tablet) As of 2026-10-28 | Tier 1/2 (Generic IR); Tier 3/4 (Generic ER) $0 – $12 copay / 30 days (IR) | No Prior Auth (Generic) No (for generic IR and most generic ER) | Drug Guide |
| Rotigotine Transdermal System (Neupro Patch) 24-Hour Transdermal Dopamine Agonist Patch NDC: 50474080103 (1mg) / 50474080203 (2mg) / 50474080603 (8mg) | Once-daily skin patch providing continuous 24-hour transdermal dopamine agonist delivery — particularly valuable when swallowing difficulties (dysphagia) or nocturnal/early-morning akinesia limit oral pills. Source: FDA Prescribing Information (NDA 021829) & Parkinson's Foundation | $880 – $1,060 / 30 days (box of 30 patches) 1 patch (2 mg, 4 mg, 6 mg, or 8 mg / 24 hr) applied once daily (30 patches / 30-day supply) | NADAC Published $846.76 – $847.42 / 30 patches (30-day supply) ($28.22517 – $28.24732 / patch) As of 2026-10-28 | Tier 3 (Preferred Brand) or Tier 4 (Non-Preferred Brand) $47–$100 copay or 25%–40% coinsurance until hitting the $2,100 annual Part D cap | Prior Auth Required Yes on ~65% of Part D plans (or Step Therapy requiring trial of oral pramipexole or ropinirole unless dysphagia/NPO status is documented) | Drug Guide |
| Rasagiline (Azilect / Generic) Selective Irreversible MAO-B Inhibitor NDC: 64980071130 (0.5mg) / 47781068330 (0.5mg) | Blocks monoamine oxidase-B (MAO-B) breakdown of dopamine in the brain, used once daily as monotherapy in early Parkinson's or as an adjunct to reduce 'OFF' time. Source: NINDS & FDA Prescribing Information | $22 – $75 / 30 days (30 generic tablets with discount/cash pricing); $180 – $360 full retail U&C 0.5 mg or 1 mg tablet once daily (30 tablets / 30-day supply) | NADAC Published $13.80 / 30 tablets (30-day supply) ($0.45985 / tablet) As of 2026-10-28 | Tier 2 (Generic) or Tier 3 $5 – $42 copay / 30 days | No Prior Auth (Generic) No on >90% of Part D plans for generic rasagiline | Drug Guide |
| Safinamide (Xadago) Reversible MAO-B Inhibitor NDC: 27505011030 (50mg) / 27505011130 (100mg) | Once-daily reversible MAO-B inhibitor approved as adjunctive treatment to levodopa/carbidopa in patients experiencing 'OFF' episodes. Source: FDA Prescribing Information (NDA 207145) & Michael J. Fox Foundation | $1,120 – $1,290 / 30 days (30 tablets) 50 mg or 100 mg tablet once daily (30 tablets / 30-day supply) | NADAC Published $1,089.77 – $1,093.77 / 30 tablets (30-day supply) ($36.32581 – $36.45907 / tablet) As of 2026-10-28 | Tier 4 (Non-Preferred Brand) or Tier 5 (Specialty) 25%–50% coinsurance until hitting the $2,100 annual Part D out-of-pocket cap ($0 thereafter) | Prior Auth Required Yes — requires documented 'OFF' episodes on carbidopa/levodopa AND trial/failure of generic rasagiline or selegiline | Drug Guide |
| Amantadine IR & Gocovri (Amantadine Extended-Release Capsules) NMDA Receptor Antagonist / Dopaminergic Modulator (Levodopa-Induced Dyskinesia & OFF Time) NDC: 23155036205 (Amantadine 100mg IR) • Gocovri ER: Limited-Distribution Specialty (Not published in CMS Retail NADAC) | Reduces levodopa-induced dyskinesia (involuntary choreiform movements) and 'OFF' episodes; Gocovri is the only FDA-approved bedtime extended-release medication specifically indicated for both dyskinesia and OFF time. Source: FDA Prescribing Information (NDA 208944) & Parkinson's Foundation | Amantadine IR: $14 – $38 / 30 days (60 caps) • Gocovri ER: $3,150 – $3,650 / 30 days (60 caps specialty pharmacy) Amantadine IR: 100 mg capsule twice daily (60 caps / 30 days) • Gocovri ER: 137 mg (2 caps) once daily at bedtime (60 caps / 30 days) | NADAC Published $8.46 / 60 capsules (Amantadine IR) • Gocovri ER: Not published in CMS Retail NADAC ($0.14096 / capsule (Amantadine 100mg IR) • Not published in Retail NADAC (Gocovri ER)) As of 2026-10-28 | Amantadine IR: Tier 1/2 (Generic, No PA) • Gocovri ER: Tier 5 (Specialty Tier, Prior Auth Required) Amantadine IR: $0–$10/mo • Gocovri ER: hits the $2,100 annual Part D out-of-pocket cap in Month 1–2, then $0/mo for the remainder of the year | Prior Auth Required No for Amantadine IR; Yes for Gocovri ER (requires documented levodopa-induced dyskinesia + trial/intolerance of generic amantadine IR) | Drug Guide |
| Entacapone (Comtan / Carbidopa-Levodopa-Entacapone Stalevo) Peripheral COMT (Catechol-O-Methyltransferase) Inhibitor NDC: 00904682207 (Entacapone 200mg) / 16571069101 (Carbidopa-Levodopa-Entacapone 25-100-200mg) | Taken with each dose of levodopa/carbidopa to block peripheral COMT breakdown of levodopa, extending the duration of each levodopa dose ('ON' time). Source: NINDS & FDA Prescribing Information | $28 – $95 / 30 days (120 generic entacapone tablets); $75 – $185 / 30 days (120 generic Stalevo combination tablets) 200 mg tablet taken with each levodopa dose, typically 4 times daily (120 tablets / 30-day supply) | NADAC Published $39.81 / 120 tablets (Entacapone) • $83.31 / 120 tablets (Combo) ($0.33178 / tablet (Entacapone 200mg) • $0.69423 / tablet (C/L/Entacapone combo)) As of 2026-10-28 | Tier 2 or Tier 3 (Generic) $5 – $42 copay / 30 days | No Prior Auth (Generic) No | Drug Guide |
| Duopa (Carbidopa / Levodopa Enteral Suspension — PEG-J Pump, HCPCS J7340) Continuous 16-Hour Jejunal Enteral Dopamine Infusion (Medicare Part B DME Benefit) NDC: 00074301228 (HCPCS J7340) | Continuous 16-hour infusion of carbidopa/levodopa gel delivered directly into the small intestine (jejunum) via a portable CADD-Legacy pump and PEG-J tube to bypass erratic gastric emptying in advanced Parkinson's. Source: FDA Prescribing Information (NDA 203952) & CMS Medicare Part B DMEPOS Policy | $7,200 – $8,800 / 30 days (30 enteral cassettes + pump supplies) 1 single-use 100 mL cassette (2,000 mg levodopa / 500 mg carbidopa) daily via CADD-Legacy 1400 pump (30 cassettes / 30-day supply) | Not published in Retail NADAC Not published in CMS Retail NADAC (Dispensed as Medicare Part B DME Enteral Infusion Drug under HCPCS J7340) As of 2026-10-28 | Covered under Medicare Part B DME (Durable Medical Equipment) — NOT Part D when infused via external CADD-Legacy pump Original Medicare + Medigap Plan G/N: $0 after $257 Part B deductible • Medicare Advantage / Original Medicare alone: 20% Part B coinsurance (up to Part C MOOP) | Prior Auth Required Yes — requires documented severe motor fluctuations / OFF time despite optimized oral therapy AND PEG-J placement | Drug Guide |
| Vyalev (Foscarbidopa / Foslevodopa 24-Hour Subcutaneous Infusion) Continuous 24-Hour Subcutaneous Levodopa Prodrug Infusion NDC: 00074050101 / 00074050107 | Non-surgical, continuous 24-hour subcutaneous infusion of soluble carbidopa/levodopa prodrugs via a small wearable pump for advanced Parkinson's motor fluctuations — delivering continuous levodopa without brain surgery or a stomach PEG-J tube. Source: FDA Approval Letter & Prescribing Information (NDA 216962, Approved Oct 2024) | $8,900 – $11,200 / 30 days (specialty pharmacy list range) Continuous 24-hour subcutaneous infusion via Vyafuser pump (single-dose 10 mL vials; ~28–30 vials / 30-day supply) | Not published in Retail NADAC Not published in CMS Retail NADAC (Limited-Distribution Specialty Infusion Drug) As of 2026-10-28 | Tier 5 (Specialty Tier) or Formulary Exception / Part B DME determination depending on carrier Reaches the $2,100 annual Part D out-of-pocket cap on Fill #1, then $0 for the rest of the calendar year | Prior Auth Required Yes — requires prescription by a neurologist, motor fluctuations (>2–3 hours/day OFF time) despite oral carbidopa/levodopa and at least 1–2 adjunct classes | Drug Guide |
| Apomorphine Subcutaneous Injection (Apokyn) Rapid-Acting Subcutaneous Dopamine Agonist ('OFF' Episode Rescue Pen) NDC: 19157000105 / 42023023205 | Fast-acting subcutaneous pen injection (works in 10–20 minutes) for acute, intermittent rescue treatment of sudden 'OFF' episodes (freezing or immobility) in advanced Parkinson's. Source: FDA Prescribing Information (NDA 021264) & Parkinson's Foundation | $2,800 – $5,600 / 30 days (depending on number of 30mg/3mL cartridges used) 0.2 mL to 0.6 mL (2 mg to 6 mg) injected subcutaneously as needed for acute OFF episodes (typically 15–30 cartridges [3 mL each] / 30 days) | Not published in Retail NADAC Not published in CMS Retail NADAC (Limited-Distribution Specialty Pharmacy Network) As of 2026-10-28 | Tier 5 (Specialty Tier) 25%–33% Specialty Tier coinsurance until hitting the $2,100 annual Part D cap ($0 thereafter) | Prior Auth Required Yes — requires documented acute 'OFF' episodes despite optimized oral dopaminergic therapy and confirmation patient is NOT taking 5-HT3 antagonists (ondansetron, etc. — severe hypotension contraindication) | Drug Guide |
| Istradefylline (Nourianz) Adenosine A2A Receptor Antagonist NDC: 42747002030 (20mg) / 42747004030 (40mg) | Non-dopaminergic once-daily oral add-on therapy to levodopa/carbidopa that targets adenosine A2A receptors in the basal ganglia to reduce daily 'OFF' time. Source: FDA Prescribing Information (NDA 022075) & Michael J. Fox Foundation | $1,680 – $1,950 / 30 days (30 tablets) 20 mg or 40 mg tablet once daily (30 tablets / 30-day supply) | Not published in Retail NADAC Not published in CMS Retail NADAC (Limited-Distribution Specialty Pharmacy) As of 2026-10-28 | Tier 5 (Specialty Tier) or Non-Formulary (requires Formulary Exception on many plans) 25%–33% Specialty coinsurance up to the $2,100 annual Part D cap (if on formulary or exception approved) | Prior Auth Required Yes — requires documented 'OFF' episodes on carbidopa/levodopa AND failure/intolerance of at least two generic adjunctive classes (dopamine agonist, MAO-B inhibitor, COMT inhibitor) | Drug Guide |
| Pimavanserin (Nuplazid — Parkinson's Disease Psychosis) Selective Serotonin Inverse Agonist (5-HT2A) — Non-Dopaminergic Antipsychotic NDC: 63090034030 | The only FDA-approved medication specifically indicated for hallucinations and delusions associated with Parkinson's disease psychosis — works on serotonin 5-HT2A receptors without blocking dopamine receptors or worsening motor symptoms. Source: FDA Prescribing Information (NDA 207318) & Parkinson's Foundation | $5,150 – $5,680 / 30 days (30 capsules) 34 mg capsule once daily (30 capsules / 30-day supply) | NADAC Published $5,114.88 / 30 capsules (30-day supply) ($170.49600 / capsule) As of 2026-10-28 | Tier 5 (Specialty Tier — Protected Class Antipsychotic) Hits the $2,100 annual Part D out-of-pocket cap on Fill #1 in January (or ~$175/mo with Medicare Prescription Payment Plan smoothing), then $0 for the rest of the year | Prior Auth Required Yes — requires diagnosis of hallucinations and/or delusions associated with Parkinson's disease psychosis (antipsychotics are a CMS Part D Protected Class, so virtually all Part D plans cover Nuplazid with diagnosis confirmation) | Drug Guide |
Carbidopa / Levodopa Immediate & Extended Release (Sinemet / Generic)
What it's for: First-line dopamine replacement therapy that crosses the blood-brain barrier to relieve bradykinesia (slowness), rigidity, and resting tremor in Parkinson's disease. (NINDS Parkinson's Disease Information Page & FDA Prescribing Information)
Rytary (Carbidopa / Levodopa Extended-Release Capsules)
What it's for: Extended-release capsule combining immediate- and delayed-release carbidopa/levodopa beads to reduce daily 'OFF' time in patients with motor fluctuations. (FDA Prescribing Information (NDA 203312) & Parkinson's Foundation Medications Guide)
Pramipexole (Mirapex / Generic IR & ER)
What it's for: Directly stimulates striatal dopamine receptors (D2/D3) as monotherapy in early Parkinson's or as an adjunct to levodopa in advanced disease. (NINDS & FDA Prescribing Information)
Ropinirole (Requip / Generic IR & XL)
What it's for: Oral dopamine receptor agonist used alone in early Parkinson's disease or alongside carbidopa/levodopa to smooth motor fluctuations. (NINDS & FDA Prescribing Information)
Rotigotine Transdermal System (Neupro Patch)
What it's for: Once-daily skin patch providing continuous 24-hour transdermal dopamine agonist delivery — particularly valuable when swallowing difficulties (dysphagia) or nocturnal/early-morning akinesia limit oral pills. (FDA Prescribing Information (NDA 021829) & Parkinson's Foundation)
Rasagiline (Azilect / Generic)
What it's for: Blocks monoamine oxidase-B (MAO-B) breakdown of dopamine in the brain, used once daily as monotherapy in early Parkinson's or as an adjunct to reduce 'OFF' time. (NINDS & FDA Prescribing Information)
Safinamide (Xadago)
What it's for: Once-daily reversible MAO-B inhibitor approved as adjunctive treatment to levodopa/carbidopa in patients experiencing 'OFF' episodes. (FDA Prescribing Information (NDA 207145) & Michael J. Fox Foundation)
Amantadine IR & Gocovri (Amantadine Extended-Release Capsules)
What it's for: Reduces levodopa-induced dyskinesia (involuntary choreiform movements) and 'OFF' episodes; Gocovri is the only FDA-approved bedtime extended-release medication specifically indicated for both dyskinesia and OFF time. (FDA Prescribing Information (NDA 208944) & Parkinson's Foundation)
Entacapone (Comtan / Carbidopa-Levodopa-Entacapone Stalevo)
What it's for: Taken with each dose of levodopa/carbidopa to block peripheral COMT breakdown of levodopa, extending the duration of each levodopa dose ('ON' time). (NINDS & FDA Prescribing Information)
Duopa (Carbidopa / Levodopa Enteral Suspension — PEG-J Pump, HCPCS J7340)
What it's for: Continuous 16-hour infusion of carbidopa/levodopa gel delivered directly into the small intestine (jejunum) via a portable CADD-Legacy pump and PEG-J tube to bypass erratic gastric emptying in advanced Parkinson's. (FDA Prescribing Information (NDA 203952) & CMS Medicare Part B DMEPOS Policy)
Vyalev (Foscarbidopa / Foslevodopa 24-Hour Subcutaneous Infusion)
What it's for: Non-surgical, continuous 24-hour subcutaneous infusion of soluble carbidopa/levodopa prodrugs via a small wearable pump for advanced Parkinson's motor fluctuations — delivering continuous levodopa without brain surgery or a stomach PEG-J tube. (FDA Approval Letter & Prescribing Information (NDA 216962, Approved Oct 2024))
Apomorphine Subcutaneous Injection (Apokyn)
What it's for: Fast-acting subcutaneous pen injection (works in 10–20 minutes) for acute, intermittent rescue treatment of sudden 'OFF' episodes (freezing or immobility) in advanced Parkinson's. (FDA Prescribing Information (NDA 021264) & Parkinson's Foundation)
Istradefylline (Nourianz)
What it's for: Non-dopaminergic once-daily oral add-on therapy to levodopa/carbidopa that targets adenosine A2A receptors in the basal ganglia to reduce daily 'OFF' time. (FDA Prescribing Information (NDA 022075) & Michael J. Fox Foundation)
Pimavanserin (Nuplazid — Parkinson's Disease Psychosis)
What it's for: The only FDA-approved medication specifically indicated for hallucinations and delusions associated with Parkinson's disease psychosis — works on serotonin 5-HT2A receptors without blocking dopamine receptors or worsening motor symptoms. (FDA Prescribing Information (NDA 207318) & Parkinson's Foundation)