Carbidopa / Levodopa Immediate & Extended Release (Sinemet / Generic): Cost, CMS NADAC & Insurance Coverage
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. (Source: NINDS Parkinson's Disease Information Page & FDA Prescribing Information)
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Cost Across Insurances Matrix for Carbidopa / Levodopa Immediate & Extended Release
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 50228045805 Carbidopa / Levodopa Immediate & Extended Release (Sinemet / Generic) | $14 – $48 / 30 days (90 tablets retail self-pay / discount card) $14 – $48 / 30 days (90 tablets retail self-pay / discount card); $65 – $140 full retail list (U&C) Source: CMS National Retail Pharmacy Cash Survey & California Pharmacy U&C Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $6.62 / 90 IR tablets CARBIDOPA-LEVODOPA 25-100 TAB ($0.07361/EA) & CARBIDOPA-LEVO ER 25-100 TAB ($0.11027/EA) • Medicare Part D patient cost: $0 – $10 copay per 30-day fill 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 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic ($5–$15 copay); no prior authorization required. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Anthem Blue Cross CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic ($5–$15 copay); no prior authorization required. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Blue Shield of CA CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic; no prior authorization (brand Dhivy fractional tablet requires PA + step therapy). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & UnitedHealthcare CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic; no prior authorization. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Aetna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic; no prior authorization. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Cigna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Formulary Generic ($5–$15 copay); no prior authorization. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Kaiser Permanente CA Commercial Formulary Date: Oct 2026 | $0 patient copay $0 copay on Medi-Cal Rx Contract Drug List (CDL) without 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
Tier 1 Generic ($5–$15 copay); no prior authorization required.
Tier 1 Generic ($5–$15 copay); no prior authorization required.
Tier 1 Generic; no prior authorization (brand Dhivy fractional tablet requires PA + step therapy).
Tier 1 Generic; no prior authorization.
Tier 1 Generic; no prior authorization.
Formulary Generic ($5–$15 copay); no prior authorization.
$0 copay on Medi-Cal Rx Contract Drug List (CDL) without prior authorization.