| Parkinson Disease
Duopa vs Onapgo
Side-by-side clinical, coverage, and cost comparison for parkinson disease.Deep comparison between: Duopa vs Onapgo with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsOnapgo has a higher rate of injection site reactions vs Duopa based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Onapgo but not Duopa, including UnitedHealthcare
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Category
Duopa
Onapgo
At A Glance
Intrajejunal infusion
Daily 16-hour infusion
Carbidopa-levodopa combination
SC injection
Daily continuous infusion
Non-ergoline dopamine agonist
Indications
- Parkinson Disease
- Parkinson Disease
Dosing
Parkinson Disease Administer via continuous 16-hour intrajejunal infusion through a PEG-J tube using the CADD-Legacy 1400 pump; dose individualized as a morning dose, continuous dose, and extra doses; maximum 2000 mg levodopa (one cassette) per day.
Parkinson Disease Initial continuous dosage 1 mg/hr SC infusion over the waking day (up to 16 hours), titrated in 0.5-1 mg/hr increments up to 6 mg/hr; extra doses of 0.5-2 mg up to 3 times/day as needed; maximum total daily dosage 98 mg.
Contraindications
- Concurrent or recent (within 2 weeks) use of nonselective MAO inhibitors (e.g., phenelzine, tranylcypromine)
- Concomitant use of 5HT3 antagonists, including antiemetics (e.g., ondansetron, granisetron, dolasetron, palonosetron) and alosetron
- Hypersensitivity or allergic reaction to apomorphine or any excipient of ONAPGO, including sulfite (sodium metabisulfite)
Adverse Reactions
Most common (>=7% greater than oral immediate-release carbidopa-levodopa) Complication of device insertion, nausea, depression, peripheral edema, hypertension, upper respiratory tract infection, oropharyngeal pain, atelectasis, incision site erythema
Serious Gastrointestinal and procedure-related risks, falling asleep during activities of daily living and somnolence, orthostatic hypotension, hallucinations/psychosis/confusion, impulse control/compulsive behaviors, depression and suicidality, withdrawal-emergent hyperpyrexia and confusion, dyskinesia, vitamin B6 deficiency and seizures, neuropathy, cardiovascular ischemic events, glaucoma
Most common (>=10%) Infusion site nodule, nausea, somnolence, infusion site erythema, dyskinesia, headache, insomnia
Serious Syncope, hypotension, orthostatic hypotension, falls, hallucinations, psychotic-like behavior, hemolytic anemia, impulse control disorders, cardiac events, QTc prolongation, hypersensitivity, fibrotic complications, priapism
Postmarketing Hemolytic anemia
Pharmacology
Carbidopa inhibits peripheral decarboxylation of levodopa, increasing levodopa availability in the brain; levodopa crosses the blood-brain barrier and is converted to dopamine, which is thought to treat the motor symptoms of Parkinson's disease.
Non-ergoline dopamine agonist with high binding affinity for the dopamine D4 receptor and moderate affinity for D2, D3, D5, and adrenergic receptors; believed to act via stimulation of post-synaptic dopamine D2-type receptors within the caudate-putamen in the brain.
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Most Common Insurance
Anthem BCBS
Duopa
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
Onapgo
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (9/12)
UnitedHealthcare
Duopa
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (0/8) · Qty limit (0/8)
Onapgo
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Duopa
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (2/3)
Onapgo
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (2/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableAssistance Fund: Parkinson's Disease
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
No savings programs available for Onapgo.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.