Signature Cross-Insurance Cost Matrix • Specialty / DME (42747002030)Adenosine A2A Receptor Antagonist

Istradefylline (Nourianz): Cost Across Insurances

Complete cell-by-cell comparison across Self-Pay Cash, Original Medicare, 6 Major California Commercial Payers (Anthem, Blue Shield, UnitedHealthcare, Aetna, Cigna, Kaiser Permanente), and Medi-Cal — with every cell labeled with its official data source and effective date.

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.

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.

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
Audit-Grade Cell Verification (9/9 Insurance Columns Sourced)

Every Insurance Cell for Istradefylline — With Source & Date Citations

Tier 1 Cash Baseline Published Rate

Self-Pay / Discounted Cash Price

$1,680 – $1,950 / 30 days (30 tablets)

$1,680 – $1,950 / 30 days (30 tablets)

Official Source: Specialty Pharmacy Published Cash & WAC Benchmarks (Oct 2026)
Effective / Verified Date: Oct 2026
Federal Benchmark Not Published

Original Medicare (CMS 2026 / NADAC / Part D)

Not published in Retail NADAC

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)

Official 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)
Effective / Verified Date: 2026-10-28
Commercial & MA MRF Not Published

Anthem Blue Cross (California)

Not published (PBM negotiated rate)

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.

Official Source: Anthem Blue Cross 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021)
Effective / Verified Date: Oct 2026
Commercial & MA MRF Not Published

Blue Shield of California

Not published (PBM negotiated rate)

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.

Official Source: Blue Shield of CA 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021)
Effective / Verified Date: Oct 2026
Commercial & MA MRF Not Published

UnitedHealthcare (UHC)

Not published (PBM negotiated rate)

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.

Official Source: UnitedHealthcare 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021)
Effective / Verified Date: Oct 2026
Commercial & MA MRF Not Published

Aetna

Not published (PBM negotiated rate)

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.

Official Source: Aetna 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021)
Effective / Verified Date: Oct 2026
Commercial MRF Not Published

Cigna

Not published (PBM negotiated rate)

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.

Official Source: Cigna 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021)
Effective / Verified Date: Oct 2026
Integrated HMO / MRF Not Published

Kaiser Permanente (Northern CA)

Not published (PBM negotiated rate)

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.

Official Source: Kaiser Permanente 2026 CA Commercial Formulary & CA Health & Safety Code § 1367.241 (SB 1021)
Effective / Verified Date: Oct 2026
$0 Safety-Net Published Rate

Medi-Cal (California Medicaid / Medi-Cal Rx)

$0 patient copay

$0 copay ONLY with approved Medi-Cal Rx Prior Authorization.

Official Source: CA DHCS Medi-Cal Rx Contract Drug List (CDL) & PA Policy
Effective / Verified Date: Oct 2026
CMS NADAC & Medicare Part D Formulary Details

Istradefylline (Nourianz) — Clinical & Formulary Summary

Open Full Medication Page

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)

CMS NADAC Baseline (2026-10-28)
Not published in CMS Retail NADAC (Limited-Distribution Specialty Pharmacy)
30-Day Baseline: Not published in CMS Retail NADAC
Source: CMS NADAC 2026 (data.medicaid.gov Dataset fbb83258-11c7-47f5-8b18-5f8e79f7e704 — Verified absent from retail survey)
2026 Medicare Part D Formulary Status
Tier: Tier 5 (Specialty Tier) or Non-Formulary (requires Formulary Exception on many plans)
Prior Auth: Yes — requires documented 'OFF' episodes on carbidopa/levodopa AND failure/intolerance of at least two generic adjunctive classes (dopamine agonist, MAO-B inhibitor, COMT inhibitor)
2026 Patient Cost: 25%–33% Specialty coinsurance up to the $2,100 annual Part D cap (if on formulary or exception approved)