Istradefylline (Nourianz): Cost, CMS NADAC & Insurance Coverage
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. (Source: FDA Prescribing Information (NDA 022075) & Michael J. Fox Foundation)
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Cost Across Insurances Matrix for Istradefylline
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 |
|---|---|---|---|---|---|---|---|---|---|
MedicationSpecialty / DME (42747002030) Istradefylline (Nourianz) | $1,680 – $1,950 / 30 days (30 tablets) $1,680 – $1,950 / 30 days (30 tablets) Source: Specialty Pharmacy Published Cash & WAC Benchmarks (Oct 2026) Date: Oct 2026 | Not published Not published in CMS Retail NADAC (Limited-Distribution Specialty Pharmacy) • Medicare Part D patient cost: 25%–33% Specialty coinsurance up to the $2,100 annual Part D cap (if on formulary or exception approved) 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 Tier 4/Specialty; Prior Authorization + 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: Anthem Blue Cross 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Tier 4/Specialty; Prior Authorization + 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: Blue Shield of CA 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Excluded or Specialty Tier with Prior Authorization + 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: UnitedHealthcare 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Non-Preferred Brand / Specialty; Prior Authorization + 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 Tier 4/Specialty; Prior Authorization + 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: Cigna 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Non-Formulary (requires specialty formulary 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 $0 copay ONLY with approved 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
Tier 4/Specialty; Prior Authorization + Step Therapy required.
Tier 4/Specialty; Prior Authorization + Step Therapy required.
Excluded or Specialty Tier with Prior Authorization + Step Therapy.
Non-Preferred Brand / Specialty; Prior Authorization + Step Therapy required.
Tier 4/Specialty; Prior Authorization + Step Therapy required.
Non-Formulary (requires specialty formulary exception).
$0 copay ONLY with approved Medi-Cal Rx Prior Authorization.