Dual-Release Microbead Dopamine Precursor (Motor Fluctuations / Wearing-Off)NDC: 64896066101 (23.75-95mg) / 64896066201 (36.25-145mg) / 64896066401 (61.25-245mg)

Rytary (Carbidopa / Levodopa Extended-Release Capsules): Cost, CMS NADAC & Insurance Coverage

What it's for: Extended-release capsule combining immediate- and delayed-release carbidopa/levodopa beads to reduce daily 'OFF' time in patients with motor fluctuations. (Source: FDA Prescribing Information (NDA 203312) & Parkinson's Foundation Medications Guide)

30-Day Retail Cash Range

$410 – $1,350 / 30 days (90–270 capsules depending on daily capsule count)

Source: CMS NADAC 2026 & Retail Specialty Pharmacy Cash Benchmarks (Oct 2026)

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

$357.42 – $449.68 per 90 capsules ($1,072 – $1,349 for 270 capsules/30 days)

Per unit: $3.97137 – $4.99647 / capsule (Brand) • $3.18395 – $3.94968 / capsule (Corresponding Generic)

2026 Medicare Part D Patient Cost

25%–45% coinsurance or $47–$100 copay until reaching the $2,100 annual Part D out-of-pocket cap ($0 thereafter)

Tier 4 (Non-Preferred Brand) or Tier 3 (Preferred Brand); Generic ER capsules on Tier 3/4

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 Rytary

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
MedicationNDC 64896066101 Rytary (Carbidopa / Levodopa Extended-Release Capsules) Drug Guide →	$410 – $1,350 / 30 days (90–270 capsules depending on daily capsule count) $410 – $1,350 / 30 days (90–270 capsules depending on daily capsule count) Source: CMS NADAC 2026 & Retail Specialty Pharmacy Cash Benchmarks (Oct 2026) Date: Oct 2026	NADAC: $357.42 – $449.68 per 90 capsules ($1,072 – $1,349 for 270 capsules/30 days) RYTARY ER 23.75-95 MG ($3.97980/EA; Generic ER $3.18395/EA) to RYTARY ER 61.25-245 MG ($4.99647/EA; Generic ER $3.94968/EA) • Medicare Part D patient cost: 25%–45% coinsurance or $47–$100 copay until reaching the $2,100 annual Part D out-of-pocket cap ($0 thereafter) Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Formulary & Utilization Management File (Oct 2026) Date: 2026-10-28	Not published Tier 3/4 with Step Therapy (must try generic carbidopa/levodopa IR & ER 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: Anthem Blue Cross 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026	Not published Tier 4 Non-Preferred / 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 Tier 3/4 with Prior Authorization and 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; 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 3/4; 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 Non-Formulary (requires formal formulary exception documenting failure of generic IR + ER + adjunct COMT/MAOB 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: Kaiser Permanente 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026	$0 patient copay $0 copay IF approved via Medi-Cal Rx Prior Authorization (requires documented failure of generic CDL carbidopa/levodopa formulations). 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: Published in CMS Retail Community Pharmacy Survey

NDC & Description: 64896066101 (23.75-95mg) / 64896066201 (36.25-145mg) / 64896066401 (61.25-245mg) — RYTARY ER 23.75-95 MG ($3.97980/EA; Generic ER $3.18395/EA) to RYTARY ER 61.25-245 MG ($4.99647/EA; Generic ER $3.94968/EA)

NADAC Per-Unit Rate: $3.97137 – $4.99647 / capsule (Brand) • $3.18395 – $3.94968 / capsule (Corresponding Generic)

Typical 30-Day Regimen (36.25 mg/145 mg or 61.25 mg/245 mg capsules, 3 capsules 3 times daily (90–270 capsules / 30-day supply)): $357.42 – $449.68 per 90 capsules ($1,072 – $1,349 for 270 capsules/30 days)

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)

CY 2026 Medicare Part D Formulary Rules

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

Formulary Tier: Tier 4 (Non-Preferred Brand) or Tier 3 (Preferred Brand); Generic ER capsules on Tier 3/4

Prior Authorization: Yes — requires documented wearing-off / motor fluctuations despite generic carbidopa/levodopa IR and ER tablets

Step Therapy: Yes — trial and inadequate response to immediate-release and generic sustained-release carbidopa/levodopa

Quantity Limits: Typically 300–450 capsules per 30 days depending on strength

2026 Patient Out-of-Pocket: 25%–45% coinsurance or $47–$100 copay until reaching the $2,100 annual Part D out-of-pocket cap ($0 thereafter)

Source: CMS CY 2026 Medicare Part D Formulary & Utilization Management File (Oct 2026)

California Commercial Payers & Medi-Cal Rx

Payer-by-Payer Formulary & Prior Authorization Notes

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Anthem Blue Cross

Tier 3/4 with Step Therapy (must try generic carbidopa/levodopa IR & ER first).

Blue Shield of California

Tier 4 Non-Preferred / Prior Authorization required.

UnitedHealthcare (UHC)

Tier 3/4 with Prior Authorization and Step Therapy.

Aetna

Non-Preferred Brand; Prior Authorization + Step Therapy required.

Cigna

Tier 3/4; Prior Authorization required.

Kaiser Permanente

Non-Formulary (requires formal formulary exception documenting failure of generic IR + ER + adjunct COMT/MAOB therapy).

Medi-Cal Rx (CA Medicaid)

$0 copay IF approved via Medi-Cal Rx Prior Authorization (requires documented failure of generic CDL carbidopa/levodopa formulations).