Continuous 16-Hour Jejunal Enteral Dopamine Infusion (Medicare Part B DME Benefit)NDC: 00074301228 (HCPCS J7340)

Duopa (Carbidopa / Levodopa Enteral Suspension — PEG-J Pump, HCPCS J7340): Cost, CMS NADAC & Insurance Coverage

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. (Source: FDA Prescribing Information (NDA 203952) & CMS Medicare Part B DMEPOS Policy)

30-Day Retail Cash Range

$7,200 – $8,800 / 30 days (30 enteral cassettes + pump supplies)

Source: CMS Medicare Part B ASP Drug Pricing File (HCPCS J7340) & Specialty Infusion Benchmarks (Oct 2026)

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

Not published in CMS Retail NADAC (Covered under Medicare Part B DMEPOS ASP + 6% fee schedule)

Per unit: Not published in Retail NADAC (Billed per 100 mL cassette under Part B HCPCS J7340)

2026 Medicare Part D Patient Cost

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)

Covered under Medicare Part B DME (Durable Medical Equipment) — NOT Part D when infused via external CADD-Legacy pump

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 Duopa

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 (00074301228) Duopa (Carbidopa / Levodopa Enteral Suspension — PEG-J Pump, HCPCS J7340) Drug Guide →	$7,200 – $8,800 / 30 days (30 enteral cassettes + pump supplies) $7,200 – $8,800 / 30 days (30 enteral cassettes + pump supplies) Source: CMS Medicare Part B ASP Drug Pricing File (HCPCS J7340) & Specialty Infusion Benchmarks (Oct 2026) Date: Oct 2026	Not published Not published in CMS Retail NADAC (Dispensed as Medicare Part B DME Enteral Infusion Drug under HCPCS J7340) • Medicare Part D patient cost: 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) Source: CMS NADAC 2026 & CMS Medicare Part B ASP Pricing File (HCPCS J7340, Oct 2026) & CMS Medicare Benefit Policy Manual Ch. 15 §110 (DME External Infusion Pumps) & HCPCS J7340 Date: 2026-10-28	Not published Medical/Specialty Pharmacy Benefit; Prior Authorization required (CG-DRUG-68). 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 Medical/Specialty Benefit; 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 Medical/Specialty Benefit; 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 Medical/Specialty Benefit; Prior Authorization required (CPB 0017 / Specialty). 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 Medical/Specialty Benefit; 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 Requires movement-disorder subspecialist board review and authorization. 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 TAR / 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: 00074301228 (HCPCS J7340) — Not published in CMS Retail NADAC (Dispensed as Medicare Part B DME Enteral Infusion Drug under HCPCS J7340)

NADAC Per-Unit Rate: Not published in Retail NADAC (Billed per 100 mL cassette under Part B HCPCS J7340)

Typical 30-Day Regimen (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 CMS Retail NADAC (Covered under Medicare Part B DMEPOS ASP + 6% fee schedule)

Effective Date / As-of Date: Effective 2026-10-01 (Verified as of 2026-10-28)

Source: CMS NADAC 2026 & CMS Medicare Part B ASP Pricing File (HCPCS J7340, Oct 2026)

CY 2026 Medicare Part D Formulary Rules

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

Formulary Tier: Covered under Medicare Part B DME (Durable Medical Equipment) — NOT Part D when infused via external CADD-Legacy pump

Prior Authorization: Yes — requires documented severe motor fluctuations / OFF time despite optimized oral therapy AND PEG-J placement

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

Quantity Limits: typically 1 cassette (100 mL) per day (up to 2 cassettes/day for high-dose patients)

2026 Patient Out-of-Pocket: 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)

Source: CMS Medicare Benefit Policy Manual Ch. 15 §110 (DME External Infusion Pumps) & HCPCS J7340

California Commercial Payers & Medi-Cal Rx

Payer-by-Payer Formulary & Prior Authorization Notes

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Anthem Blue Cross

Medical/Specialty Pharmacy Benefit; Prior Authorization required (CG-DRUG-68).

Blue Shield of California

Medical/Specialty Benefit; Prior Authorization required.

UnitedHealthcare (UHC)

Medical/Specialty Benefit; Prior Authorization required.

Aetna

Medical/Specialty Benefit; Prior Authorization required (CPB 0017 / Specialty).

Cigna

Medical/Specialty Benefit; Prior Authorization required.

Kaiser Permanente

Requires movement-disorder subspecialist board review and authorization.

Medi-Cal Rx (CA Medicaid)

$0 copay with approved TAR / Medi-Cal Rx Prior Authorization.