Payer PolicyActive
Apomorphine (Apokyn)
EVICORE-MEDICAL_DRUG-E78223DE
EviCore by Evernorth
Effective: November 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covers Apokyn (apomorphine) only for the acute, intermittent treatment of hypomobility "off" episodes in patients with FDA‑approved advanced Parkinson’s disease; off‑label uses are not authorized. Approval requires current carbidopa/levodopa therapy, documented current "off" episodes, prior trials of at least two other "off" treatments, neurologist prescription/consultation, subcutaneous administration only with a starting dose of 0.2 mL (2 mg) titratable to 0.6 mL (6 mg), supporting documentation of prior treatments and benefit, and is authorized for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Apokyn (apomorphine) is indicated for the acute, intermittent treatment of hypomobility "off" episodes ("end-of-dose wearing off" and unpredictable "on/off" episodes) with advanced Parkinson's dise..."
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