Rapid-Acting Subcutaneous Dopamine Agonist ('OFF' Episode Rescue Pen)NDC: 19157000105 / 42023023205

Apomorphine Subcutaneous Injection (Apokyn): Cost, CMS NADAC & Insurance Coverage

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. (Source: FDA Prescribing Information (NDA 021264) & Parkinson's Foundation)

30-Day Retail Cash Range

$2,800 – $5,600 / 30 days (depending on number of 30mg/3mL cartridges used)

Source: Specialty Pharmacy Published Pricing & Generic Apomorphine Cartridge Benchmarks (Oct 2026)

CMS NADAC Baseline (As of 2026-10-28)

Not published in CMS Retail NADAC (Specialty pharmacy distribution with nurse titration onboarding)

Per unit: Not published in Retail NADAC

2026 Medicare Part D Patient Cost

25%–33% Specialty Tier coinsurance until hitting the $2,100 annual Part D cap ($0 thereafter)

Tier 5 (Specialty Tier)

1. Published Prices(Cash & Medicare)2. Plan-Adjusted(Payer MRF Rate)3. Verified Price(Real-Time 270/271 Check)

Accuracy Level — Tier 1 Published Prices: You are currently viewing general published hospital cash prices, Medicare baselines, and multi-payer ranges. Add your insurance card to unlock Tier 2 plan pricing and Tier 3 verified benefit checks.

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Cost Across Insurances Matrix for Apomorphine Subcutaneous Injection

Tier 1: General Published Rates Across 9 InsurancesEvery cell labeled with official Source + Date • “Not published” shown honestly where proprietary

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.

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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
MedicationSpecialty / DME (19157000105) Apomorphine Subcutaneous Injection (Apokyn) Drug Guide →	$2,800 – $5,600 / 30 days (depending on number of 30mg/3mL cartridges used) $2,800 – $5,600 / 30 days (depending on number of 30mg/3mL cartridges used) Source: Specialty Pharmacy Published Pricing & Generic Apomorphine Cartridge Benchmarks (Oct 2026) Date: Oct 2026	Not published Not published in CMS Retail NADAC (Limited-Distribution Specialty Pharmacy Network) • Medicare Part D patient cost: 25%–33% Specialty Tier coinsurance until hitting the $2,100 annual Part D cap ($0 thereafter) Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704 — Verified absent from retail survey) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28	Not published Specialty Tier; Prior Authorization 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: Anthem Blue Cross 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026	Not published Specialty Tier; Prior Authorization 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: Blue Shield of CA 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026	Not published Specialty Tier; Prior Authorization 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 Specialty Tier; Prior Authorization 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 Specialty Tier; Prior Authorization 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 Specialty Formulary Exception 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: Kaiser Permanente 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026	$0 patient copay $0 copay with approved Medi-Cal Rx Prior Authorization. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026

Official CMS NADAC Acquisition Cost Baseline

National Average Drug Acquisition Cost (NADAC)

Published Status: Not published in CMS Retail NADAC (Specialty / Part B DME distribution)

NDC & Description: 19157000105 / 42023023205 — Not published in CMS Retail NADAC (Limited-Distribution Specialty Pharmacy Network)

NADAC Per-Unit Rate: Not published in Retail NADAC

Typical 30-Day Regimen (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 CMS Retail NADAC (Specialty pharmacy distribution with nurse titration onboarding)

Effective Date / As-of Date: Effective 2026-10-21 (Verified as of 2026-10-28)

Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704 — Verified absent from retail survey)

CY 2026 Medicare Part D Formulary Rules

Medicare Part D Tier, Prior Auth & $2,100 Cap

Formulary Tier: Tier 5 (Specialty Tier)

Prior Authorization: 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)

Step Therapy: Yes (oral carbidopa/levodopa + oral adjunct)

Quantity Limits: Typically 60–90 mL per 30 days

2026 Patient Out-of-Pocket: 25%–33% Specialty Tier coinsurance until hitting the $2,100 annual Part D cap ($0 thereafter)

Source: CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026)

California Commercial Payers & Medi-Cal Rx