Subject: Specialty Quantity Limit Duopa 6714-H P2025

Drug

DUOPA  (carbidopa/levodopa enteral suspension)

Policy:

Program Description

The standard limit is designed to allow a quantity sufficient for the most common uses of the medication. The recommended dosing parameters for all FDA indications fall within the standard limits. Coverage of an additional quantity may be reviewed on a case-by-case basis upon request.

Covered Quantities

Medication	Standard Limit
Duopa (carbidopa/levodopa enteral suspension)   4.63 mg/20 mg per mL (100 mL single-use cassette)	28 cassettes per 28 days

FDA-recommended Dosing

Prior to initiation of therapy, convert patients from all other forms of levodopa to oral immediate-release carbidopa-levodopa tablets.

The daily dose is determined by individualized patient titration and composed of a morning dose, a continuous dose, and extra doses. It can be titrated as needed, based on the patient’s individual clinical response and tolerability after Day 1 of therapy and until a stable daily dose is maintained.

The maximum recommended daily dose is 2000 mg of the levodopa component (i.e., one cassette per day) administered over 16 hours. Patients will take their night-time dose of oral immediate-release carbidopa-levodopa tablets at the end of the daily 16-hour infusion.

Place of Service:

Outpatient

The above policy is based on the following references:

1. Duopa [package insert]. North Chicago, IL: AbbVie Inc.; May 2025.

Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

February 15, 2026