Amantadine IR & Gocovri (Amantadine Extended-Release Capsules): Cost, CMS NADAC & Insurance Coverage
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. (Source: FDA Prescribing Information (NDA 208944) & Parkinson's Foundation)
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Cost Across Insurances Matrix for Amantadine IR & Gocovri
Hospital procedure cells are extracted from 14 Bay Area hospital MRFs (45 CFR § 180.50, Oct 2026); medication cells use CMS NADAC (as of 2026-10-28) & CY 2026 Medicare Part D / Medi-Cal Rx rules.
| Parkinson's Service / Medication | Self-Pay / Cash Price Hospital MRF / Retail Cash | Medicare Rate 2026 CMS / NADAC / Part D | Anthem Blue Cross MRF Negotiated / Formulary | Blue Shield of CA MRF Negotiated / Formulary | UnitedHealthcare MRF Negotiated / Formulary | Aetna MRF Negotiated / Formulary | Cigna MRF Negotiated / Formulary | Kaiser Permanente MRF Negotiated / Formulary | Medi-Cal (CA Medicaid) CA DHCS / Medi-Cal Rx |
|---|---|---|---|---|---|---|---|---|---|
MedicationNDC 23155036205 Amantadine IR & Gocovri (Amantadine Extended-Release Capsules) | Amantadine IR: $14 – $38 / 30 days (60 caps) • Gocovri ER: $3,150 – $3,650 / 30 days (60 caps specialty pharmacy) Amantadine IR: $14 – $38 / 30 days (60 caps) • Gocovri ER: $3,150 – $3,650 / 30 days (60 caps specialty pharmacy) Source: CMS NADAC 2026 (Amantadine IR) & Specialty Pharmacy Published WAC/Cash Range (Gocovri, Oct 2026) Date: Oct 2026 | NADAC: $8.46 / 60 capsules (Amantadine IR) AMANTADINE 100 MG CAPSULE ($0.14096/EA) • GOCOVRI ER: Not published in CMS Retail NADAC (dispensed via specialty pharmacy) • Medicare Part D patient cost: 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 Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28 | Not published Amantadine IR: Tier 1 (No PA) • Gocovri: Tier 4/Specialty with Prior Auth + Step Therapy (generic amantadine IR). Commercial insurer-PBM net negotiated drug price is proprietary; CA SB 1021 caps state-regulated commercial copay at ≤ $250/30d if PA is approved. Source: Anthem Blue Cross 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Tier with Prior Auth + Step Therapy. Commercial insurer-PBM net negotiated drug price is proprietary; CA SB 1021 caps state-regulated commercial copay at ≤ $250/30d if PA is approved. Source: Blue Shield of CA 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth required. Commercial insurer-PBM net negotiated drug price is proprietary; CA SB 1021 caps state-regulated commercial copay at ≤ $250/30d if PA is approved. Source: UnitedHealthcare 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth + Step Therapy required. Commercial insurer-PBM net negotiated drug price is proprietary; CA SB 1021 caps state-regulated commercial copay at ≤ $250/30d if PA is approved. Source: Aetna 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth required. Commercial insurer-PBM net negotiated drug price is proprietary; CA SB 1021 caps state-regulated commercial copay at ≤ $250/30d if PA is approved. Source: Cigna 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Amantadine IR: Formulary Generic ($5–$15) • Gocovri: Non-Formulary (requires specialty exception). Commercial insurer-PBM net negotiated drug price is proprietary; CA SB 1021 caps state-regulated commercial copay at ≤ $250/30d if PA is approved. Source: Kaiser Permanente 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | $0 patient copay Amantadine IR: $0 on Medi-Cal Rx CDL • Gocovri: $0 with Medi-Cal Rx Prior Authorization. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
National Average Drug Acquisition Cost (NADAC)
Medicare Part D Tier, Prior Auth & $2,100 Cap
Payer-by-Payer Formulary & Prior Authorization Notes
Amantadine IR: Tier 1 (No PA) • Gocovri: Tier 4/Specialty with Prior Auth + Step Therapy (generic amantadine IR).
Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Tier with Prior Auth + Step Therapy.
Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth required.
Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth + Step Therapy required.
Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth required.
Amantadine IR: Formulary Generic ($5–$15) • Gocovri: Non-Formulary (requires specialty exception).
Amantadine IR: $0 on Medi-Cal Rx CDL • Gocovri: $0 with Medi-Cal Rx Prior Authorization.