Vyalev (Foscarbidopa / Foslevodopa 24-Hour Subcutaneous Infusion): Cost, CMS NADAC & Insurance Coverage
What it's for: Non-surgical, continuous 24-hour subcutaneous infusion of soluble carbidopa/levodopa prodrugs via a small wearable pump for advanced Parkinson's motor fluctuations — delivering continuous levodopa without brain surgery or a stomach PEG-J tube. (Source: FDA Approval Letter & Prescribing Information (NDA 216962, Approved Oct 2024))
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Cost Across Insurances Matrix for Vyalev
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 (00074050101) Vyalev (Foscarbidopa / Foslevodopa 24-Hour Subcutaneous Infusion) | $8,900 – $11,200 / 30 days (specialty pharmacy list range) $8,900 – $11,200 / 30 days (specialty pharmacy list range) Source: Manufacturer Wholesale Acquisition Cost (WAC) Disclosure & Specialty Pharmacy Benchmarks (Oct 2026) Date: Oct 2026 | Not published Not published in CMS Retail NADAC (Limited-Distribution Specialty Infusion Drug) • Medicare Part D patient cost: Reaches the $2,100 annual Part D out-of-pocket cap on Fill #1, then $0 for the rest of the calendar year Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704 — Verified absent from retail survey) & CMS CY 2026 Medicare Part D Specialty Formulary Rules (Oct 2026) Date: 2026-10-28 | Not published Specialty Pharmacy Prior Authorization required (documented persistent OFF time despite optimized oral 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: Anthem Blue Cross 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Specialty Pharmacy 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 Specialty Pharmacy 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 Specialty Pharmacy 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: Aetna 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Specialty Pharmacy 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 Specialty (requires movement-disorder subspecialist exception review). 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. 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 Pharmacy Prior Authorization required (documented persistent OFF time despite optimized oral therapy).
Specialty Pharmacy Prior Authorization required.
Specialty Pharmacy Prior Authorization required.
Specialty Pharmacy Prior Authorization required.
Specialty Pharmacy Prior Authorization required.
Non-Formulary Specialty (requires movement-disorder subspecialist exception review).
$0 copay IF approved via Medi-Cal Rx Prior Authorization.