Signature Cross-Insurance Cost Matrix • Specialty / DME (00074050101)Continuous 24-Hour Subcutaneous Levodopa Prodrug Infusion

Vyalev (Foscarbidopa / Foslevodopa 24-Hour Subcutaneous Infusion): 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 (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
Audit-Grade Cell Verification (9/9 Insurance Columns Sourced)

Every Insurance Cell for Vyalev — With Source & Date Citations

Tier 1 Cash Baseline Published Rate

Self-Pay / Discounted Cash Price

$8,900 – $11,200 / 30 days (specialty pharmacy list range)

$8,900 – $11,200 / 30 days (specialty pharmacy list range)

Official Source: Manufacturer Wholesale Acquisition Cost (WAC) Disclosure & Specialty Pharmacy 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 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

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 Specialty Formulary Rules (Oct 2026)
Effective / Verified Date: 2026-10-28
Commercial & MA MRF Not Published

Anthem Blue Cross (California)

Not published (PBM negotiated rate)

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.

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)

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.

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)

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.

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)

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.

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)

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.

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 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.

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 IF approved via 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

Vyalev (Foscarbidopa / Foslevodopa 24-Hour Subcutaneous Infusion) — Clinical & Formulary Summary

Open Full Medication Page

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))

CMS NADAC Baseline (2026-10-28)
Not published in CMS Retail NADAC (Limited-Distribution Specialty Infusion Drug)
30-Day Baseline: Not published in CMS Retail NADAC (Dispensed exclusively via specialty pharmacy)
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 Formulary Exception / Part B DME determination depending on carrier
Prior Auth: Yes — requires prescription by a neurologist, motor fluctuations (>2–3 hours/day OFF time) despite oral carbidopa/levodopa and at least 1–2 adjunct classes
2026 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