Parkinson's Disease

Aetna covers levodopa or apomorphine challenge when PD is uncertain, olfactory (UPSIT/”Sniffin’ Sticks”) and neuropsychological testing for PD diagnosis, and SPECT DaTSCAN only to distinguish PD from essential tremor (SPECT for distinguishing PD from other parkinsonian syndromes or for monitoring progression is experimental/investigational and excluded). Carbidopa‑levodopa enteral suspension (Duopa) is covered only for motor fluctuations in advanced PD meeting specified criteria (patients must be converted from oral immediate‑release carbidopa‑levodopa at a 1:4 levodopa ratio prior to initiation, max 2000 mg levodopa/day over 16 hours, and Duopa is contraindicated with nonselective MAO inhibitors); Duopa for other indications and pallidotomy for Parkinson’s plus/atypical disorders, severe dementia/cerebral atrophy, or Hoehn & Yahr Stage V are considered not indicated/experimental.

"lack of a pre-specified plan for adjustment of the 95 % CIs for multiple comparisons of secondary outcomes, no definite inferences could be made from these data."