CurrentCignaPolicy IP0524

Parkinson's Disease - Nourianz

Defines Cigna coverage and prior authorization criteria for Nourianz as adjunctive treatment to carbidopa/levodopa in adults with Parkinson's disease experiencing 'off' episodes; applies to Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyParkinson's Disease - Nourianz

Policy CodePolicy IP0524

Change TypeMaterial revisions to criteria and preferred product language

Effective Date

Next Review Date

Key ActionObtain prior authorization and ensure the patient is currently taking carbidopa/levodopa, experiencing 'off' episodes, and prescribed by or in consultation with a neurologist.

SourceLink

POLICY UPDATE CHANGES

Policy name updated from 'Istradefylline' to 'Parkinson's Disease - Nourianz.'

Removed the age requirement of 18 years or older for Parkinson's disease treatment.

Updated criterion from 'currently receiving levodopa-based treatment' to 'currently taking carbidopa/levodopa.'

Preferred product requirement criteria moved to preferred product table and wording adjusted (e.g., 'Patients already started on Nourianz' and 'Tried' replaces 'Failure, contraindication, or intolerance').

1 yearApproval duration

1Required prior trial

IP0524Policy number

07/01/2024; 06/15/2025Annual revisions

Policy Summary

PayerCigna

PolicyParkinson's Disease - Nourianz

Policy CodePolicy IP0524

Change TypeMaterial revisions to criteria and preferred product language

Effective Date

Next Review Date

Key ActionObtain prior authorization and ensure the patient is currently taking carbidopa/levodopa, experiencing 'off' episodes, and prescribed by or in consultation with a neurologist.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria for Nourianz (istradefylline)

Initial Approval (FDA-Approved Indication)

Approve for 1 year if the patient meets ALL of the following (A, B, C, and D):

FDA-Approved Indication

A) Patient is currently taking carbidopa/levodopa.
B) Patient is experiencing 'off' episodes.
Examples of 'off' episodes include muscle stiffness, slow movements, or difficulty starting movements.
C) The medication is prescribed by or in consultation with a neurologist.
D) Preferred product criteria is met for the product as listed in the preferred product table.

Preferred Product / Step Therapy

Employer and Individual/Family Plans: Approve when ONE of the following is met:

Preferred product criteria

1) Tried ONE of the following agents: cabergoline, entacapone, pramipexole, rasagiline, ropinirole, selegiline, tolcapone, apomorphine.
2) Patient already started on Nourianz.

Nourianz (istradefylline) for any use other than those specified in this policy is considered not medically necessary. This includes uses outside the Parkinson's disease indication and any scenarios not meeting the coverage criteria and preferred-product requirements described in this policy.

Use of Nourianz for indications other than Parkinson's disease as specified in this policy is considered not medically necessary. Coverage is limited to the FDA‑approved adjunctive use with carbidopa/levodopa for patients who meet the policy's clinical and step-therapy requirements.

Provider Actions, Prior Authorization, and Billing

Prior Authorization

Prior Authorization Required — Prior authorization is recommended

Prior Authorization is recommended for Nourianz (istradefylline). Approval is provided for 1 year when all policy criteria are met. Because specialized skills are required for evaluation/monitoring, Nourianz must be prescribed by or in consultation with a physician who specializes in the condition being treated (see prescriber requirement).

Approval duration: 1 year when criteria are met
Prior authorization recommended for prescription benefit coverage

Step Therapy

Step Therapy / Trial Requirement — Trial of ONE listed alternative agent

For Employer and Individual/Family plans, a trial of ONE listed alternative agent is required unless the member is already started on Nourianz. Listed alternatives include: cabergoline, entacapone, pramipexole, rasagiline, ropinirole, selegiline, tolcapone, or apomorphine. If the patient is already receiving Nourianz, this step requirement is satisfied.

Employer Plans: trial of ONE listed agent or patients already started on Nourianz

Background

Nourianz (istradefylline) is an adenosine A2A receptor antagonist indicated as adjunctive therapy to carbidopa/levodopa for patients with Parkinson's disease who experience "off" episodes. The policy approves treatment for 1 year when all FDA‑approved indication criteria are met, including current use of carbidopa/levodopa, documented "off" episodes, and prescriber/consultation with a neurologist; employer and individual/ family plan requirements (such as trial of an alternative agent or prior use of Nourianz) also apply.

Definitions

'Off' episodes — examples

Definition'Off' episodes: fluctuations in motor function during which Parkinson's disease symptoms worsen; examples include muscle stiffness, slow movements, or difficulty starting movements.

Clinical examplesMuscle stiffness (rigidity).

Clinical examplesBradykinesia — slow movements.

Clinical examplesDifficulty initiating movements (akinesia).