Pimavanserin (Nuplazid — Parkinson's Disease Psychosis): Cost, CMS NADAC & Insurance Coverage
What it's for: The only FDA-approved medication specifically indicated for hallucinations and delusions associated with Parkinson's disease psychosis — works on serotonin 5-HT2A receptors without blocking dopamine receptors or worsening motor symptoms. (Source: FDA Prescribing Information (NDA 207318) & Parkinson's Foundation)
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Cost Across Insurances Matrix for Pimavanserin
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 63090034030 Pimavanserin (Nuplazid — Parkinson's Disease Psychosis) | $5,150 – $5,680 / 30 days (30 capsules) $5,150 – $5,680 / 30 days (30 capsules) Source: CMS NADAC 2026 ($5,114.88 acquisition baseline) & Specialty Pharmacy Cash Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $5,114.88 / 30 capsules (30-day supply) NUPLAZID 34 MG CAPSULE ($170.49600/EA) • Medicare Part D patient cost: Hits the $2,100 annual Part D out-of-pocket cap on Fill #1 in January (or ~$175/mo with Medicare Prescription Payment Plan smoothing), then $0 for the rest of the year Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Protected Class Formulary Rules (Oct 2026) Date: 2026-10-28 | Not published Specialty Tier; Prior Authorization confirming Parkinson's disease psychosis. 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 confirming Parkinson's disease psychosis. 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 confirming Parkinson's disease psychosis. 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 confirming Parkinson's disease psychosis. 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 confirming Parkinson's disease psychosis. 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 RequiresPrior Authorization / Psychiatry or Movement-Disorder Neurology approval (quetiapine or clozapine often trialed first). 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 Medi-Cal Rx Prior Authorization confirming Parkinson's disease psychosis. 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
Specialty Tier; Prior Authorization confirming Parkinson's disease psychosis.
Specialty Tier; Prior Authorization confirming Parkinson's disease psychosis.
Specialty Tier; Prior Authorization confirming Parkinson's disease psychosis.
Specialty Tier; Prior Authorization confirming Parkinson's disease psychosis.
Specialty Tier; Prior Authorization confirming Parkinson's disease psychosis.
RequiresPrior Authorization / Psychiatry or Movement-Disorder Neurology approval (quetiapine or clozapine often trialed first).
$0 copay with Medi-Cal Rx Prior Authorization confirming Parkinson's disease psychosis.