Parkinson's Disease Drugs, Oral & Topical
PDL Reference Documents
- Parkinson's Disease - Feb 06, 2025
- Parkinson's Disease - Oct 01, 2020
- Anti-Parkinson's Agents - Mar 22, 2018
- Anti-Parkinson's Agents - Jul 28, 2016
- Anti-Parkinson's Agents - Sep 23, 2014
- Parkinsons Disease: Abbreviated Class Update - Nov 21, 2013
- Abbreviated Class Update: Parkinson's Drugs - Sep 26, 2013
- Class Scan: Anti-Parkinson's Agents - Feb 23, 2012
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation & Updates |
---|---|---|---|---|---|
amantadine HCl | AMANTADINE | CAPSULE | Y | ||
amantadine HCl | AMANTADINE | TABLET | Y | ||
benztropine mesylate | BENZTROPINE MESYLATE | TABLET | Y | ||
carbidopa/levodopa | SINEMET 25-100 | TABLET | Y | ||
carbidopa/levodopa | SINEMET 10-100 | TABLET | Y | ||
carbidopa/levodopa | CARBIDOPA/LEVODOPA | TABLET | Y | ||
carbidopa/levodopa | DHIVY | TABLET | Y | ||
carbidopa/levodopa | CARBIDOPA-LEVODOPA | TABLET | Y | ||
carbidopa/levodopa | CARBIDOPA-LEVODOPA ER | TABLET ER | Y | ||
carbidopa/levodopa/entacapone | STALEVO 75 | TABLET | Y | ||
carbidopa/levodopa/entacapone | STALEVO 50 | TABLET | Y | ||
carbidopa/levodopa/entacapone | STALEVO 125 | TABLET | Y | ||
carbidopa/levodopa/entacapone | STALEVO 100 | TABLET | Y | ||
carbidopa/levodopa/entacapone | CARBIDOPA-LEVODOPA-ENTACAPONE | TABLET | Y | ||
entacapone | ENTACAPONE | TABLET | Y | ||
pramipexole di-HCl | PRAMIPEXOLE DIHYDROCHLORIDE | TABLET | Y | ||
selegiline HCl | SELEGILINE HCL | CAPSULE | Y | ||
trihexyphenidyl HCl | TRIHEXYPHENIDYL HCL | SOLUTION | Y | ||
trihexyphenidyl HCl | TRIHEXYPHENIDYL HCL | TABLET | Y | ||
amantadine HCl | GOCOVRI | CAP ER 24H | N | PA Document | |
amantadine HCl | AMANTADINE | SOLUTION | N | PA Document | |
amantadine HCl | OSMOLEX ER | TAB BP 24H | N | PA Document | |
apomorphine HCl | KYNMOBI | FILM | N | PA Document | |
bromocriptine mesylate | BROMOCRIPTINE MESYLATE | CAPSULE | N | PA Document | |
bromocriptine mesylate | BROMOCRIPTINE MESYLATE | TABLET | N | PA Document | |
carbidopa | LODOSYN | TABLET | N | PA Document | |
carbidopa | CARBIDOPA | TABLET | N | PA Document | |
carbidopa/levodopa | CREXONT | CAP IR ER | N | PA Document | |
carbidopa/levodopa | RYTARY | CAPSULE ER | N | PA Document | |
carbidopa/levodopa | DUOPA | INT PMP SP | N | PA Document | |
carbidopa/levodopa | CARBIDOPA-LEVODOPA | TAB RAPDIS | N | PA Document | |
istradefylline | NOURIANZ | TABLET | N | PA Document | |
levodopa | INBRIJA | CAP W/DEV | N | PA Document | |
levodopa | INBRIJA | CAPSULE | N | PA Document | |
levodopa | LARODOPA | TABLET | N | PA Document | |
opicapone | ONGENTYS | CAPSULE | N | PA Document | |
pramipexole di-HCl | PRAMIPEXOLE ER | TAB ER 24H | N | PA Document | |
rasagiline mesylate | AZILECT | TABLET | N | PA Document | |
rasagiline mesylate | RASAGILINE MESYLATE | TABLET | N | PA Document | |
ropinirole HCl | ROPINIROLE ER | TAB ER 24H | N | PA Document | |
ropinirole HCl | ROPINIROLE HCL | TABLET | N | PA Document | |
rotigotine | NEUPRO | PATCH TD24 | N | PA Document | |
safinamide mesylate | XADAGO | TABLET | N | PA Document | |
selegiline HCl | ZELAPAR | TAB RAPDIS | N | PA Document | |
selegiline HCl | SELEGILINE HCL | TABLET | N | PA Document | |
tolcapone | TASMAR | TABLET | N | PA Document | |
tolcapone | TOLCAPONE | TABLET | N | PA Document | |
apomorphine HCl | ONAPGO | CARTRIDGE | |||
foscarbidopa/foslevodopa | VYALEV | VIAL |