Parkinson's Cost Across Insurances: Cash | Medicare | 6 Major Payers | Medi-Cal
Compare all 9 Parkinson's Care Pathway procedures (extracted from 14 Bay Area hospital Machine-Readable Files, 45 CFR § 180.50) and all 14 Parkinson's medications (CMS NADAC as of 2026-10-28 & CY 2026 Medicare Part D) in one view. Every single cell cites its official source and date, and shows “Not published” honestly where a payer's proprietary rate is not publicly disclosed.
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.
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 |
|---|---|---|---|---|---|---|---|---|---|
Pathway ServiceCPT 61885 Deep Brain Stimulation (DBS) Surgery — Lead & Neurostimulator Implant | $337,921 Self-pay discounted cash / negotiated spread ($4,610–$467,890 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $24,865 CMS IPPS/OPPS allowed baseline ($1,648 Part A deductible; $0 with Medigap Plan G/N) Source: CMS CY 2026 Hospital Outpatient Prospective Payment System (APC 5464 Level 4 Neurostimulator Procedures: $24,865) & Inpatient MS-DRG 024 Base Payment ($36,420) under NCD 160.24 Date: CY 2026 (Jan 2026) | $4,792–$233,391 Negotiated across 10 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Cross (Anthem Medicare Managed Care Plan) ($60,935); UCSF Medical Center (SF): Blue Cross (Anthem Medi-Cal Managed Care Plan) ($141,490)) Source: Bay Area Hospital MRFs (10/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $5,542–$433,931 Negotiated across 11 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Covered California Other Commercial Plan) ($7,145); UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($56,425)) Source: Bay Area Hospital MRFs (11/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $16,172–$337,921 Negotiated across 14 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($54,168); UCSF Medical Center (SF): Unitedhealthcare (Non-Hmo Other Commercial Plan) ($247,121)) Source: Bay Area Hospital MRFs (14/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $5,227–$531,679 Negotiated across 13 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Aetna (All Commercial Plans) ($144,881); Stanford Hospital (Palo Alto): Aetna (All Commercial Plans) ($16,973)) Source: Bay Area Hospital MRFs (13/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $4,610–$415,903 Negotiated across 7 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Cigna (All Commercial Plans) ($69,092); Stanford Hospital (Palo Alto): Cigna (Ppo) ($25,837)) Source: Bay Area Hospital MRFs (7/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $46,506–$280,734 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Kaiser Permanente (All Commercial Plans) ($46,506); Washington Hospital (Fremont): KAISER MCR ADV ($63,861)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$19,892) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
Pathway ServiceCPT 78803 DaTscan — Dopamine Transporter Brain SPECT Imaging (CPT 78803 + A9584) | $390–$5,478 Self-pay discounted cash / negotiated spread ($389–$16,079 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $1,308.45 CMS 2026 allowed rate (~$261.69 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Hospital Outpatient Prospective Payment System (OPPS APC 5593 Level 3 Nuclear Medicine) & MPFS (CPT 78803 + HCPCS A9584) Date: CY 2026 (Jan 2026) | $747–$12,230 Negotiated across 6 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC MCR ADV ($774); Washington Hospital (Fremont): ANTHEM BC FEDERAL EMPLOYEES ($1,406)) Source: Bay Area Hospital MRFs (6/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $993–$13,202 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($993); Stanford Tri-Valley (Pleasanton): Blue Shield (HMO/POS) ($2,419)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $953–$11,002 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($953); Washington Hospital (Fremont): UHC DOCTORS PLAN PPO/EP ($1,338)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $794–$8,688 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): AETNA MCR ADV ($794); Washington Hospital (Fremont): AETNA-ALL OTHER PLANS ($1,377)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $1,208–$13,540 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): CIGNA NEW BUS OAP ($1,208)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $1,051–$9,140 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): KAISER MEDI-CAL ($1,945); Washington Hospital (Fremont): KAISER - ALL OTHER PLANS ($1,051)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$1,047) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
Pathway ServiceCPT 70551 Brain MRI Without Contrast | $1,719–$5,481 Self-pay discounted cash / negotiated spread ($135–$8,227 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $339.26 CMS 2026 allowed rate (~$67.85 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Hospital Outpatient Prospective Payment System (OPPS APC 5523) & Medicare Physician Fee Schedule (Noridian JE Bay Area Locality) Date: CY 2026 (Jan 2026) | $278–$5,724 Negotiated across 14 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Cross (Anthem Medicare Managed Care Plan) ($504); UCSF Medical Center (SF): Blue Cross (Anthem Medi-Cal Managed Care Plan) ($492)) Source: Bay Area Hospital MRFs (14/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $167–$8,227 Negotiated across 14 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($436); UCSF Medical Center (SF): Blue Shield (Covered California Other Commercial Plan) ($3,939)) Source: Bay Area Hospital MRFs (14/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $354–$5,363 Negotiated across 14 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($419); UCSF Medical Center (SF): Unitedhealthcare (Apple Other Commercial Plan) ($3,264)) Source: Bay Area Hospital MRFs (14/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $349–$4,971 Negotiated across 14 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Aetna (All Commercial Plans) ($3,951); Stanford Hospital (Palo Alto): Aetna (All Commercial Plans) ($4,971)) Source: Bay Area Hospital MRFs (14/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $2,522–$7,447 Negotiated across 14 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Cigna (All Commercial Plans) ($4,180); Stanford Hospital (Palo Alto): Cigna (Hmo/Pos) ($4,439)) Source: Bay Area Hospital MRFs (14/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $349–$4,770 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Kaiser Permanente (All Commercial Plans) ($4,770); Washington Hospital (Fremont): KAISER MEDI-CAL ($439)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$271) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
Pathway ServiceCPT 99204 Neurology Consult & Movement Disorder Specialist Follow-Up (CPT 99204 / 99214) | $170–$623 Self-pay discounted cash / negotiated spread ($23–$1,247 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $194.82 CMS 2026 allowed rate (~$38.96 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Medicare Physician Fee Schedule (CPT 99204 New Consult: $194.82 Bay Area Locality; CPT 99214 Follow-Up: $138.60) & OPPS APC 5012 Clinic Visit Date: CY 2026 (Jan 2026) | $64–$910 Negotiated across 7 Bay Area hospital MRFs (e.g., Stanford Hospital (Palo Alto): Blue Card (Out Of State) [40000] (Anthem Blue Cross) ($323); Stanford Hospital (Palo Alto): Blue Cross Medi-Cal [31100] (Anthem Blue Cross) ($323)) Source: Bay Area Hospital MRFs (7/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $60–$983 Negotiated across 4 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($243); Stanford Hospital (Palo Alto): American Specialty Health Plan Alt Payer [971000000] (Blue Shield) ($468)) Source: Bay Area Hospital MRFs (4/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $74–$1,089 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($234); Stanford Hospital (Palo Alto): Uhc West Comm Alt Payer [913600000] (United Health Care) ($412)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $81–$895 Negotiated across 2 Bay Area hospital MRFs (e.g., Stanford Hospital (Palo Alto): Aetna [10200] (Aetna) ($363); Washington Hospital (Fremont): AETNA MCR ADV ($195)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $71–$1,008 Negotiated across 2 Bay Area hospital MRFs (e.g., Stanford Hospital (Palo Alto): Cigna [11000] (Cigna Hmo) ($182); Washington Hospital (Fremont): CIGNA NEW BUS OAP ($312)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $62–$680 Negotiated across 2 Bay Area hospital MRFs (e.g., Stanford Hospital (Palo Alto): Kaiser Northern Ca [12900] (Multiplan) ($340); Washington Hospital (Fremont): KAISER MCR ADV ($195)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$156) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
Pathway ServiceCPT 97110 Physical Therapy — Therapeutic Exercise (Per 15-Min Unit) | $58–$268 Self-pay discounted cash / negotiated spread ($16–$336 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $35.91 CMS 2026 allowed rate (~$7.18 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Medicare Physician & Outpatient Therapy Fee Schedule (CPT 97110) Date: CY 2026 (Jan 2026) | $30–$256 Negotiated across 5 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC FEDERAL EMPLOYEES ($256); Summit Medical Center (Oakland): Anthem (Medicare Adv_ HMO / PPO) ($30)) Source: Bay Area Hospital MRFs (5/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $36–$207 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($38); Stanford Tri-Valley (Pleasanton): Blue Shield (HMO/POS) ($118)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $36–$306 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($37); Washington Hospital (Fremont): UHC MCR ADV ($36)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $36–$189 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): AETNA MCR ADV ($36); Washington Hospital (Fremont): AETNA-ALL OTHER PLANS ($189)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $165–$283 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): CIGNA NEW BUS OAP ($220)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $16–$191 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): KAISER MCR ADV ($36); Washington Hospital (Fremont): KAISER MEDI-CAL ($16)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$29) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
Pathway ServiceCPT 97535 Occupational Therapy — Parkinson's ADL, Fine Motor & Home Safety (CPT 97535 / 97165) | $70–$240 Self-pay discounted cash / negotiated spread ($16–$905 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $36.4 CMS 2026 allowed rate (~$7.28 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Medicare Outpatient Therapy Fee Schedule (CPT 97535 per 15-min unit: $34.13; CPT 97165 OT Evaluation: $105.94) Date: CY 2026 (Jan 2026) | $40–$654 Negotiated across 5 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC HMO/IFP ($199); Washington Hospital (Fremont): ANTHEM BC MCR ADV ($40)) Source: Bay Area Hospital MRFs (5/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $41–$706 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($132); Stanford Tri-Valley (Pleasanton): Blue Shield (HMO/POS) ($138)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $41–$782 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($127); Washington Hospital (Fremont): UHC MCR ADV ($41)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $41–$643 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): AETNA MCR ADV ($41); Washington Hospital (Fremont): AETNA-ALL OTHER PLANS ($253)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $218–$724 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): CIGNA NEW BUS OAP ($222)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $16–$489 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): KAISER MCR ADV ($41); Washington Hospital (Fremont): KAISER - ALL OTHER PLANS ($193)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$29) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
Pathway ServiceCPT 92507 Speech Therapy (incl. LSVT LOUD Voice & Dysarthria Therapy — CPT 92507) | $92–$646 Self-pay discounted cash / negotiated spread ($61–$954 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $83.88 CMS 2026 allowed rate (~$16.78 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Medicare Outpatient Therapy Fee Schedule (CPT 92507 Individual Speech Therapy Session: $83.88; CPT 92523 Evaluation: $265.50) Date: CY 2026 (Jan 2026) | $84–$726 Negotiated across 5 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC HMO/IFP ($361); Summit Medical Center (Oakland): Anthem (Medicare Adv_ HMO / PPO) ($84)) Source: Bay Area Hospital MRFs (5/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $105–$783 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($105); Stanford Tri-Valley (Pleasanton): Blue Shield (HMO/POS) ($401)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $93–$868 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($101); Washington Hospital (Fremont): UHC MCR ADV ($93)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $93–$713 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): AETNA MCR ADV ($93); Washington Hospital (Fremont): AETNA-ALL OTHER PLANS ($459)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $189–$803 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): CIGNA NEW BUS OAP ($401)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $81–$542 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): KAISER MCR ADV ($93); Washington Hospital (Fremont): KAISER MEDI-CAL ($81)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$67) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
Pathway ServiceCPT 92611 Swallow Study — Modified Barium Swallow / Videofluoroscopy (CPT 92611 + 74230) | $288–$1,137 Self-pay discounted cash / negotiated spread ($57–$1,245 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $256.58 CMS 2026 allowed rate (~$51.32 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Hospital Outpatient Prospective Payment System & MPFS (CPT 92611 Motion Fluoroscopic Swallow Eval: $95.91 + CPT 74230 Fluoroscopy: $256.58) Date: CY 2026 (Jan 2026) | $66–$915 Negotiated across 6 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC MCR ADV ($66); Washington Hospital (Fremont): ANTHEM BC FEDERAL EMPLOYEES ($809)) Source: Bay Area Hospital MRFs (6/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $67–$1,245 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($321); Stanford Tri-Valley (Pleasanton): Blue Shield (HMO/POS) ($482)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $308–$1,095 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($308); Washington Hospital (Fremont): SUTTER SELECT (UMR)-ALL PLANS ($728)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $67–$899 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): AETNA MCR ADV ($67); Washington Hospital (Fremont): AETNA-ALL OTHER PLANS ($795)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $696–$1,013 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): CIGNA NEW BUS OAP ($696)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $70–$684 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): KAISER MEDI-CAL ($70); Washington Hospital (Fremont): KAISER - ALL OTHER PLANS ($605)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$205) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
Pathway ServiceCPT 99349 Home Health & Neuromuscular Rehab Visit (CPT 99349 / CPT 97112) | $63–$278 Self-pay discounted cash / negotiated spread ($18–$529 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026 | $178.5 CMS 2026 allowed rate (~$35.7 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Home Health Prospective Payment System (LUPA Per-Visit Rate) & MPFS (CPT 99349 Home Visit & CPT 97112 Neuromuscular Re-education) Date: CY 2026 (Jan 2026) | $40–$529 Negotiated across 6 Bay Area hospital MRFs (e.g., Stanford Hospital (Palo Alto): Blue Card (Out Of State) [40000] (Anthem Blue Cross) ($345); Stanford Hospital (Palo Alto): Blue Cross Medi-Cal [31100] (Anthem Blue Cross) ($345)) Source: Bay Area Hospital MRFs (6/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $52–$529 Negotiated across 4 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($52); Stanford Hospital (Palo Alto): American Specialty Health Plan Alt Payer [971000000] (Blue Shield) ($529)) Source: Bay Area Hospital MRFs (4/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $41–$471 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($50); Stanford Hospital (Palo Alto): Uhc West Comm Alt Payer [913600000] (United Health Care) ($471)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $41–$417 Negotiated across 2 Bay Area hospital MRFs (e.g., Stanford Hospital (Palo Alto): Aetna [10200] (Aetna) ($417); Washington Hospital (Fremont): AETNA MCR ADV ($41)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $189–$276 Negotiated across 2 Bay Area hospital MRFs (e.g., Stanford Hospital (Palo Alto): Cigna [11000] (Cigna Hmo) ($219); Washington Hospital (Fremont): CIGNA NEW BUS OAP ($189)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $18–$319 Negotiated across 2 Bay Area hospital MRFs (e.g., Stanford Hospital (Palo Alto): Kaiser Northern Ca [12900] (Multiplan) ($319); Washington Hospital (Fremont): KAISER MCR ADV ($41)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01 | $0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$143) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026 |
MedicationNDC 50228045805 Carbidopa / Levodopa Immediate & Extended Release (Sinemet / Generic) | $14 – $48 / 30 days (90 tablets retail self-pay / discount card) $14 – $48 / 30 days (90 tablets retail self-pay / discount card); $65 – $140 full retail list (U&C) Source: CMS National Retail Pharmacy Cash Survey & California Pharmacy U&C Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $6.62 / 90 IR tablets CARBIDOPA-LEVODOPA 25-100 TAB ($0.07361/EA) & CARBIDOPA-LEVO ER 25-100 TAB ($0.11027/EA) • Medicare Part D patient cost: $0 – $10 copay per 30-day fill Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic ($5–$15 copay); no prior authorization required. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Anthem Blue Cross CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic ($5–$15 copay); no prior authorization required. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Blue Shield of CA CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic; no prior authorization (brand Dhivy fractional tablet requires PA + step therapy). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & UnitedHealthcare CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic; no prior authorization. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Aetna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic; no prior authorization. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Cigna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Formulary Generic ($5–$15 copay); no prior authorization. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Kaiser Permanente CA Commercial Formulary Date: Oct 2026 | $0 patient copay $0 copay on Medi-Cal Rx Contract Drug List (CDL) without prior authorization. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
MedicationNDC 64896066101 Rytary (Carbidopa / Levodopa Extended-Release Capsules) | $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 |
MedicationNDC 68462033290 Pramipexole (Mirapex / Generic IR & ER) | $12 – $38 / 30 days (90 generic IR tablets) $12 – $38 / 30 days (90 generic IR tablets); $95 – $240 / 30 days (generic ER) Source: CMS NADAC 2026 & Retail Pharmacy Cash Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $4.95 – $5.85 / 90 tablets (30-day supply) PRAMIPEXOLE 0.5 MG TABLET ($0.05497/EA) & PRAMIPEXOLE 0.75 MG TABLET ($0.06502/EA) • Medicare Part D patient cost: $0 – $12 copay / 30 days (IR) Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR); no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Anthem Blue Cross CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR); no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Blue Shield of CA CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR); no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & UnitedHealthcare CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR); no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Aetna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR); no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Cigna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Formulary Generic (IR); no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Kaiser Permanente CA Commercial Formulary Date: Oct 2026 | $0 patient copay $0 copay on Medi-Cal Rx Contract Drug List (IR). Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
MedicationNDC 69452035820 Ropinirole (Requip / Generic IR & XL) | $11 – $35 / 30 days (90 generic IR tablets) $11 – $35 / 30 days (90 generic IR tablets); $45 – $130 / 30 days (generic ER/XL) Source: CMS NADAC 2026 & Retail Pharmacy Cash Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $4.15 – $5.68 / 90 tablets (30-day supply) ROPINIROLE HCL 1 MG TABLET ($0.04613/EA) & ROPINIROLE HCL 2 MG TABLET ($0.06311/EA) • Medicare Part D patient cost: $0 – $12 copay / 30 days (IR) Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR); Tier 2/3 (ER). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Anthem Blue Cross CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR); Tier 2/3 (ER). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Blue Shield of CA CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & UnitedHealthcare CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Aetna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 1 Generic (IR). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Cigna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Formulary Generic (IR). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Kaiser Permanente CA Commercial Formulary Date: Oct 2026 | $0 patient copay $0 copay on Medi-Cal Rx Contract Drug List. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
MedicationNDC 50474080103 Rotigotine Transdermal System (Neupro Patch) | $880 – $1,060 / 30 days (box of 30 patches) $880 – $1,060 / 30 days (box of 30 patches) Source: CMS NADAC 2026 & Retail Pharmacy Cash Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $846.76 – $847.42 / 30 patches (30-day supply) NEUPRO 1 MG/24 HR PATCH ($28.23329/EA), NEUPRO 2 MG/24 HR PATCH ($28.24732/EA), NEUPRO 8 MG/24 HR PATCH ($28.22517/EA) • Medicare Part D patient cost: $47–$100 copay or 25%–40% coinsurance until hitting the $2,100 annual Part D cap Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28 | Not published Tier 3/4; Step Therapy (oral pramipexole/ropinirole) or clinical exception for dysphagia. 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; 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 Tier 3/4; 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: UnitedHealthcare 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Tier 3/4; 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; 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 formulary exception, typically granted for documented severe dysphagia or perioperative NPO status). 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 documenting dysphagia or failure of oral CDL dopamine agonists. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
MedicationNDC 64980071130 Rasagiline (Azilect / Generic) | $22 – $75 / 30 days (30 generic tablets with discount/cash pricing) $22 – $75 / 30 days (30 generic tablets with discount/cash pricing); $180 – $360 full retail U&C Source: CMS NADAC 2026 & Retail Pharmacy Cash Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $13.80 / 30 tablets (30-day supply) RASAGILINE MESYLATE 0.5 MG TAB ($0.45985/EA) • Medicare Part D patient cost: $5 – $42 copay / 30 days Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Anthem Blue Cross CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Blue Shield of CA CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & UnitedHealthcare CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Aetna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Cigna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Formulary Generic (or Selegiline first-line depending on regional protocol). (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Kaiser Permanente CA Commercial Formulary Date: Oct 2026 | $0 patient copay $0 copay on Medi-Cal Rx Contract Drug List. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
MedicationNDC 27505011030 Safinamide (Xadago) | $1,120 – $1,290 / 30 days (30 tablets) $1,120 – $1,290 / 30 days (30 tablets) Source: CMS NADAC 2026 & Retail Pharmacy Cash Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $1,089.77 – $1,093.77 / 30 tablets (30-day supply) XADAGO 50 MG TABLET ($36.45907/EA) & XADAGO 100 MG TABLET ($36.32581/EA) • Medicare Part D patient cost: 25%–50% coinsurance until hitting 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 Public Formulary File (Oct 2026) Date: 2026-10-28 | Not published Tier 4 Non-Preferred Brand; Prior Authorization + Step Therapy (rasagiline/selegiline) 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 Tier 4 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; 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; 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 formulary exception after generic selegiline and rasagiline). 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 documenting failure/intolerance of generic selegiline and rasagiline. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
MedicationNDC 23155036205 Amantadine IR & Gocovri (Amantadine Extended-Release Capsules) | Amantadine IR: $14 – $38 / 30 days (60 caps) • Gocovri ER: $3,150 – $3,650 / 30 days (60 caps specialty pharmacy) Amantadine IR: $14 – $38 / 30 days (60 caps) • Gocovri ER: $3,150 – $3,650 / 30 days (60 caps specialty pharmacy) Source: CMS NADAC 2026 (Amantadine IR) & Specialty Pharmacy Published WAC/Cash Range (Gocovri, Oct 2026) Date: Oct 2026 | NADAC: $8.46 / 60 capsules (Amantadine IR) AMANTADINE 100 MG CAPSULE ($0.14096/EA) • GOCOVRI ER: Not published in CMS Retail NADAC (dispensed via specialty pharmacy) • Medicare Part D patient cost: Amantadine IR: $0–$10/mo • Gocovri ER: hits the $2,100 annual Part D out-of-pocket cap in Month 1–2, then $0/mo for the remainder of the year Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28 | Not published Amantadine IR: Tier 1 (No PA) • Gocovri: Tier 4/Specialty with Prior Auth + Step Therapy (generic amantadine IR). 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 Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Tier with Prior Auth + 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: Blue Shield of CA 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth 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 Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth + 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 Amantadine IR: Tier 1 (No PA) • Gocovri: Specialty Prior Auth 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 Amantadine IR: Formulary Generic ($5–$15) • Gocovri: Non-Formulary (requires specialty 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 Amantadine IR: $0 on Medi-Cal Rx CDL • Gocovri: $0 with Medi-Cal Rx Prior Authorization. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
MedicationNDC 00904682207 Entacapone (Comtan / Carbidopa-Levodopa-Entacapone Stalevo) | $28 – $95 / 30 days (120 generic entacapone tablets) $28 – $95 / 30 days (120 generic entacapone tablets); $75 – $185 / 30 days (120 generic Stalevo combination tablets) Source: CMS NADAC 2026 & Retail Pharmacy Cash Benchmarks (Oct 2026) Date: Oct 2026 | NADAC: $39.81 / 120 tablets (Entacapone) ENTACAPONE 200 MG TABLET ($0.33178/EA) & CARBIDOPA-LEVODOPA-ENTACAPONE 25-100-200 MG TAB ($0.69423/EA) • Medicare Part D patient cost: $5 – $42 copay / 30 days Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704) & CMS CY 2026 Medicare Part D Public Formulary File (Oct 2026) Date: 2026-10-28 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Anthem Blue Cross CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Blue Shield of CA CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & UnitedHealthcare CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Aetna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Tier 2 Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Cigna CA Commercial Formulary Date: Oct 2026 | $5–$20 / 30d (Tier 1/2 Copay) Formulary Generic; no PA. (Covered CA 2026 standard generic copay design; plan-specific PBM net rebate price not publicly published) Source: Covered CA 2026 Standard Benefit Design & Kaiser Permanente CA Commercial Formulary Date: Oct 2026 | $0 patient copay $0 copay on Medi-Cal Rx Contract Drug List. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
MedicationSpecialty / DME (00074301228) Duopa (Carbidopa / Levodopa Enteral Suspension — PEG-J Pump, HCPCS J7340) | $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 |
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 |
MedicationSpecialty / DME (19157000105) Apomorphine Subcutaneous Injection (Apokyn) | $2,800 – $5,600 / 30 days (depending on number of 30mg/3mL cartridges used) $2,800 – $5,600 / 30 days (depending on number of 30mg/3mL cartridges used) Source: Specialty Pharmacy Published Pricing & Generic Apomorphine Cartridge Benchmarks (Oct 2026) Date: Oct 2026 | Not published Not published in CMS Retail NADAC (Limited-Distribution Specialty Pharmacy Network) • Medicare Part D patient cost: 25%–33% Specialty Tier coinsurance until hitting the $2,100 annual Part D cap ($0 thereafter) 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 Specialty Tier; 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: Anthem Blue Cross 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | Not published Specialty Tier; 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 Tier; 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 Tier; 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 Tier; 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 Specialty Formulary Exception 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: Kaiser Permanente 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021) Date: Oct 2026 | $0 patient copay $0 copay with approved Medi-Cal Rx Prior Authorization. Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy Date: Oct 2026 |
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 |
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 |
Open Any Procedure or Medication Signature Matrix Page
Each service and medication below has its own dedicated cross-insurance matrix URL with cell-by-cell source verification and hospital/formulary notes: