Juvmo

Budget impact modelIn development

Overview

Estimates the change in a United States health plan's drug spending over 3 years when Juvmo (tavapadon) is used by adults with Parkinson's disease, either without levodopa or as an adjunct to levodopa in patients with motor fluctuations.

Perspective

United States third-party payer (health plan); drug acquisition costs

Time horizon

3 years, undiscounted

Price basis

Reported wholesale acquisition cost for Juvmo, istradefylline, and amantadine extended-release; National Average Drug Acquisition Cost for the week of 23 September 2026 for the other comparators; 2026 US dollars, before rebates

Inputs checked

2026-10-01

Every field can be changed, and the results recalculate as it is. A field is marked with the basis of its value, which links to the quote, data row, or assumption behind it. PMPM is the cost per member per month.

Target population

Market share

Share of eligible patients on each treatment during each year. None of the costed classes takes whatever share the other rows leave. Assumption

Treatment costs

Cost per patient per year on treatment

Results

Budget impact by year

Budget impact by cost category

Patients on treatment and treatment cost, by treatment

Sensitivity analysis

One-way sensitivity analysis of the 3-year budget impact

Each input is set to its low and its high value in turn, with every other value as entered above. The 10 inputs that move the result most are shown; the vertical line marks the current result, +$2,012,491.

Scenario analyses

Inputs and sources

A value on a quoted source carries the quote as the evidence report holds it, linked to the document it came from. A value on published data names the row of the file it was read from. An assumption is a value no source states.

• Plan members

  1,000,000Assumption

  A hypothetical health plan of 1,000,000 members, the size against which per member per month results are conventionally reported.

• Prevalence of diagnosed Parkinson's disease, not receiving levodopa

  92.14 per 100,000Range 89.08 per 100,000 to 191.42 per 100,000Quoted source

  ICER applied a prevalence of approximately 0.34% to the whole United States population, which is 340 per 100,000 members of a plan with the national age mix. Among Medicare beneficiaries with prevalent Parkinson's disease, 81% were prescribed an antiparkinsonian drug and 90% of those treated were on levodopa, so 81% x 90% = 72.9% received levodopa and 27.1% did not (19% untreated and 8.1% on another drug): 340 x 27.1% = 92.14. The low bound uses 82% treated (340 x 26.2%). The high bound uses a newly diagnosed claims cohort, in which 4932 of 11,280 patients (43.7%) started levodopa and 56.3% did not (340 x 56.3%). Prevalence by insurance type is applied in the commercial and Medicare scenarios.

  • “by the prevalence of Parkinson’s disease (approximately 0.34%)”

    SourceICER evidence report (2026)

  • “The majority of PD patients (range, 81–82%) were prescribed at least 1 anti‐Parkinson drug each year.”

    SourceDahodwala et al. (2017)

  • “Of the treated patients, 90% were on l‐dopa therapy. This was followed by therapy with dopamine agonists (29–31%), MAOB inhibitors (9–11%), amantadine (7–8%), COMTIs (6–8%), and anticholinergics (5–6%) (Table 2).”

    SourceDahodwala et al. (2017)

  • “Of the 113,647 patients who had at least one diagnosis code for PD in the IBM MarketScan database, 11,280 fulfilled the study criteria and were included in the US study.”

    SourceKalilani et al. (2019)

  • “4932 (70.1)”

    SourceKalilani et al. (2019)

  • Exhibit A 1, Insurance: Private: 99,423 persons; population 138,862,094; prevalence 0.07%

    SourceThe Lewin Group (2026)

  • Exhibit A 1, Insurance: Medicare: 945,452 persons; population 73,280,221; prevalence 1.29%

    SourceThe Lewin Group (2026)

• Prevalence of diagnosed Parkinson's disease, receiving levodopa

  247.86 per 100,000Range 148.58 per 100,000 to 250.92 per 100,000Quoted source

  The prevalence of 340 per 100,000 members (ICER, approximately 0.34%) multiplied by the share receiving levodopa: 81% prescribed an antiparkinsonian drug x 90% of those on levodopa = 72.9%, and 340 x 72.9% = 247.86. The high bound uses 82% treated (340 x 73.8%). The low bound uses a newly diagnosed claims cohort, in which 4932 of 11,280 patients (43.7%) started levodopa; ICER applied that share to its add-on population (340 x 43.7%). Prevalence by insurance type is applied in the commercial and Medicare scenarios.

  • “by the prevalence of Parkinson’s disease (approximately 0.34%)”

    SourceICER evidence report (2026)

  • “The majority of PD patients (range, 81–82%) were prescribed at least 1 anti‐Parkinson drug each year.”

    SourceDahodwala et al. (2017)

  • “Of the treated patients, 90% were on l‐dopa therapy. This was followed by therapy with dopamine agonists (29–31%), MAOB inhibitors (9–11%), amantadine (7–8%), COMTIs (6–8%), and anticholinergics (5–6%) (Table 2).”

    SourceDahodwala et al. (2017)

  • “Of the 113,647 patients who had at least one diagnosis code for PD in the IBM MarketScan database, 11,280 fulfilled the study criteria and were included in the US study.”

    SourceKalilani et al. (2019)

  • “4932 (70.1)”

    SourceKalilani et al. (2019)

  • “yielding 436,786 patients. To size the add-on candidate population, we multiplied the same population and prevalence by the proportion treated with levodopa (43.7%),”

    SourceICER evidence report (2026)

  • Exhibit A 1, Insurance: Private: 99,423 persons; population 138,862,094; prevalence 0.07%

    SourceThe Lewin Group (2026)

  • Exhibit A 1, Insurance: Medicare: 945,452 persons; population 73,280,221; prevalence 1.29%

    SourceThe Lewin Group (2026)

• Patients not on levodopa who meet the criteria for use

  100%Assumption

  The indication is the treatment of Parkinson's disease in adults, and efficacy without levodopa was established in two trials, so no further criterion narrows this segment in the base case. A plan that applies a coverage criterion, such as a trial of a generic dopamine agonist or MAO-B inhibitor, enters the share of the segment that meets it.

  • “JUVMO is indicated for the treatment of Parkinson’s disease (PD) in adults.”

    SourceJuvmo prescribing information (2026)

  • “The efficacy of JUVMO for the treatment of PD in adults not on concomitant levodopa was established in two 27-week randomized, multicenter, double-blind, placebo-controlled studies, Study 1 (NCT04201093) and Study 2 (NCT04223193).”

    SourceJuvmo prescribing information (2026)

• Patients on levodopa who have motor fluctuations (OFF episodes)

  44%Range 41% to 54.3%Quoted source

  Efficacy as an adjunct to levodopa was established in a trial of patients with motor fluctuations. In a United States survey of patients treated with carbidopa and levodopa, 321 of 722 (44%) had OFF episodes. The low bound is 41% of 1,309 patients in a second report of that survey, and the high bound is the 54.3% cumulative incidence of motor fluctuations at 5 years in an incident cohort.

  • “Data from 722 patients were analyzed. Overall, 321 patients (44%) had “OFF” episodes (mean of 2.9 h of daily “OFF” time).”

    SourceThach et al. (2021a)

  • “Of 1,309 patients, 41% experienced "OFF" episodes, 25% of whom were "OFF" ≥4 h/day.”

    SourceThach et al. (2021b)

  • “Eighty‐three patients developed MF, with a cumulative incidence of 54.3% and 100% at 5 and 10 years, respectively.”

    SourceKim et al. (2020)

  • “The efficacy of JUVMO for the treatment of PD as adjunctive therapy to levodopa was established in a 27-week, double-blind, randomized, placebo-controlled, parallel-group, flexible-dose trial, Study 3 (NCT04542499).”

    SourceJuvmo prescribing information (2026)

• Juvmo, cost of a 30-day supply

  $4,900Range $1,232.03 to $4,900Quoted source

  The list price reported by a William Blair analyst is $4,900 per 30-day supply, and ICER's public meeting slides of 1 October 2026 list a reported wholesale acquisition cost of $58,800 per year (12 supplies). AbbVie has published no price statement, and pricing by strength and for the titration pack is not public, so one price is applied to every patient. The model costs 365.25 days per year, which is 12.175 supplies or $59,657.50 per patient-year. The low bound is ICER's placeholder of $15,000 per year (15,000 / 365.25 x 30 = $1,232.03); the reported list price is the high bound because a net price would be lower.

  • “Matt Phipps notes that Juvmo carries a list price of $4,900 per 30-day supply, or $58,800 annually.”

    SourceBenzinga (2026)

  • “$58,800”

    SourceICER public meeting slides (2026)

  • “Because tavapadon had not yet received regulatory approval, a placeholder price of $15,000 per year (as reported by IPD Analytics) was used as the intervention acquisition cost in both models. In Model 1, levodopa was costed at the median generic wholesale acquisition cost (WAC) from RED BOOK ($289 per year), consistent with ICER Reference Case guidance for generic agents. In Model 2, the dopamine agonist comparator used a market-basket approach: market-share weights were derived from a 2024 Merative MarketScan Medicare Supplemental analysis restricted to the three most-dispensed agents and normalized to 100% (ropinirole 51.9%, pramipexole 41.6%, rotigotine 6.4%), and annual WAC for each agent was sourced from RED BOOK (with the SSR Health net price applied for rotigotine), yielding a weighted-average annual dopamine agonist cost of $3,588.”

    SourceICER evidence report (2026)

  • “AbbVie did not respond to a Reuters request for comment on the drug’s launch and pricing.”

    SourceARY News (2026)

• Dopamine agonists, cost of 30 days

  $60.23Range $6.32 to $294.70Published data

  A basket weighted by the MarketScan 2024 shares ICER reports (ropinirole 51.9%, pramipexole 41.6%, rotigotine 6.4%, which total 99.9%) at the doses ICER costed and the National Average Drug Acquisition Cost per unit: ropinirole 3 mg three times daily, 90 x 0.07680 = $6.91; pramipexole 1 mg three times daily, 90 x 0.06192 = $5.57; rotigotine 2 mg per 24 hours patch daily, 30 x 28.26022 = $847.81. Weighted mean $60.23. The low bound is the two generic tablets alone ($6.32). The high bound is ICER's basket at wholesale acquisition cost, $3,588 per year (3,588 / 365.25 x 30 = $294.70).

  • ROPINIROLE HCL 3 MG TABLET: nadac_per_unit 0.07680, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • PRAMIPEXOLE 1 MG TABLET: nadac_per_unit 0.06192, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • NEUPRO 2 MG/24 HR PATCH: nadac_per_unit 28.26022, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • “Because tavapadon had not yet received regulatory approval, a placeholder price of $15,000 per year (as reported by IPD Analytics) was used as the intervention acquisition cost in both models. In Model 1, levodopa was costed at the median generic wholesale acquisition cost (WAC) from RED BOOK ($289 per year), consistent with ICER Reference Case guidance for generic agents. In Model 2, the dopamine agonist comparator used a market-basket approach: market-share weights were derived from a 2024 Merative MarketScan Medicare Supplemental analysis restricted to the three most-dispensed agents and normalized to 100% (ropinirole 51.9%, pramipexole 41.6%, rotigotine 6.4%), and annual WAC for each agent was sourced from RED BOOK (with the SSR Health net price applied for rotigotine), yielding a weighted-average annual dopamine agonist cost of $3,588.”

    SourceICER evidence report (2026)

  • “For Model 1, levodopa utilization was informed by the NMA, with the annual carbidopa/levodopa acquisition cost reflecting one 25 mg/100 mg tablet taken eight times daily. For Model 2, a market-basket approach reflected the mix of dopamine agonists used in practice, with annual acquisition costs based on ropinirole HCl 3 mg three times daily, pramipexole dihydrochloride IR 1 mg three times daily, and rotigotine 2 mg/24-hour transdermal patch once daily.”

    SourceICER evidence report (2026)

• MAO-B inhibitors, cost of 30 days

  $50.71Range $40.57 to $60.85Published data

  A basket weighted by Medicare Part D beneficiaries in 2024 (rasagiline 31,737, selegiline 11,299, safinamide 759; 72.5%, 25.8%, 1.7%) at the labeled doses and the National Average Drug Acquisition Cost per unit: rasagiline 1 mg once daily, 30 x 0.92551 = $27.77; selegiline 5 mg twice daily, 60 x 0.75631 = $45.38; safinamide 100 mg once daily, 30 x 36.32581 = $1,089.77. Weighted mean $50.71. Bounds are 20% either side.

  • RASAGILINE MESYLATE 1 MG TAB: nadac_per_unit 0.92551, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • SELEGILINE HCL 5 MG CAPSULE: nadac_per_unit 0.75631, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • XADAGO 100 MG TABLET: nadac_per_unit 36.32581, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • Tot_Benes_2024, Mftr_Name Overall: Rasagiline Mesylate 31737; Selegiline HCl 11299; Xadago 759

    SourceCenters for Medicare and Medicaid Services Part D Spending by Drug (2026)

  • “When AZILECT is prescribed as monotherapy or as adjunct therapy in patients not taking levodopa, patients may start AZILECT at the recommended dose of 1 mg administered orally once daily.”

    SourceAzilect prescribing information (2020)

  • “The recommended regimen for the administration of selegiline hydrochloride is 10 mg per day administered as divided doses of 5 mg each taken at breakfast and lunch.”

    SourceSelegiline hydrochloride capsules prescribing information (2014)

  • “The recommended starting dosage of XADAGO is 50 mg administered orally once daily (at the same time of day), without regard to meals. After two weeks, the dosage may be increased to 100 mg once daily, based on individual need and tolerability.”

    SourceXadago prescribing information (2021)

• COMT inhibitors, cost of 30 days

  $120.57Range $96.46 to $144.68Published data

  A basket weighted by Medicare Part D beneficiaries in 2024 (entacapone 26,289, carbidopa-levodopa-entacapone 9,136, opicapone 3,276; 67.9%, 23.6%, 8.5%) at the National Average Drug Acquisition Cost per unit. Entacapone and the combination tablet are taken with each levodopa dose, costed at 5 per day, the middle of the 4 to 6 doses per day in the entacapone trials: 150 x 0.32457 = $48.69 and 150 x 0.69542 = $104.31. Opicapone 50 mg once daily: 30 x 24.76028 = $742.81. Weighted mean $120.57. The combination tablet's cost includes its levodopa. Bounds are 20% either side.

  • ENTACAPONE 200 MG TABLET: nadac_per_unit 0.32457, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • CARBIDOPA-LEVODOPA-ENTACAPONE 25-100-200 MG TAB: nadac_per_unit 0.69542, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • ONGENTYS 50 MG CAPSULE: nadac_per_unit 24.76028, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • Tot_Benes_2024, Mftr_Name Overall: Entacapone 26289; Carbidopa-Levodopa-Entacapone 9136; Ongentys 3276

    SourceCenters for Medicare and Medicaid Services Part D Spending by Drug (2026)

  • “patients were randomized to receive placebo or entacapone 200 mg administered concomitantly with each dose of levodopa and carbidopa (up to 10 times daily, but averaging 4 doses to 6 doses per day)”

    SourceEntacapone tablets prescribing information (2023)

  • “The recommended dosage of ONGENTYS is 50 mg administered orally once daily at bedtime.”

    SourceOngentys prescribing information (2025)

• Amantadine, cost of 30 days

  $149.34Range $8.55 to $179.21Published data

  A basket weighted by Medicare Part D beneficiaries in 2024 (generic amantadine 104,318, which includes use outside Parkinson's disease, and Gocovri 4,906; 95.5% and 4.5%). Generic amantadine 100 mg twice daily at the National Average Drug Acquisition Cost: 60 x 0.14251 = $8.55. Gocovri 274 mg (two 137 mg capsules) once daily at the wholesale acquisition cost of a 60-capsule package filed for 1 January 2023: $3,142.96. Weighted mean $149.34. The low bound is generic amantadine alone; the high bound is 20% above the base case.

  • AMANTADINE 100 MG CAPSULE: nadac_per_unit 0.14251, pricing_unit EA, as_of_date 2026-09-23

    SourceMedicaid.gov National Average Drug Acquisition Cost (2026)

  • Gocovri Oral Capsule Extended Release 24 Hour 137 MG Package Size 60 Package Quantity 1: WAC After Increase 3142.96, WAC Effective Date 01/01/2023

    SourceCalifornia Department of Health Care Access and Information Prescription Drug Wholesale Acquisition Cost Increases (2026)

  • Tot_Benes_2024, Mftr_Name Overall: Amantadine 104318; Gocovri 4906

    SourceCenters for Medicare and Medicaid Services Part D Spending by Drug (2026)

  • “The initial daily dosage of GOCOVRI is 137 mg, administered orally once daily at bedtime. After one week, increase to the recommended dosage of 274 mg (two 137 mg capsules) once daily at bedtime.”

    SourceGocovri prescribing information (2026)

• Istradefylline, cost of a 90-tablet package

  $5,678.15Range $4,542.52 to $6,813.78Published data

  The wholesale acquisition cost of Nourianz 20 mg or 40 mg, 90 tablets, filed for 5 January 2024: $5,678.15, at one tablet daily. Bounds are 20% either side.

  • Nourianz Oral Tablet 20 MG, 90 Each, Bottle: WAC After Increase 5678.15, WAC Effective Date 01/05/2024

    SourceCalifornia Department of Health Care Access and Information Prescription Drug Wholesale Acquisition Cost Increases (2026)

  • “The recommended dosage of NOURIANZ is 20 mg administered orally once daily. The dosage may be increased to a maximum of 40 mg once daily, based on individual need and tolerability.”

    SourceNourianz prescribing information (2023)

• Days covered by a 30-day supply

  30 daysAssumption

  Costs of Juvmo and of the class baskets are stated per 30 days of treatment.

• Days covered by a 90-tablet package of istradefylline

  90 daysAssumption

  One tablet daily, so a package of 90 tablets covers 90 days.

  • “The recommended dosage of NOURIANZ is 20 mg administered orally once daily. The dosage may be increased to a maximum of 40 mg once daily, based on individual need and tolerability.”

    SourceNourianz prescribing information (2023)

• Days supplied as a share of days on treatment, all treatments

  100%Range 62% to 100%Assumption

  A share counts patients on a treatment, and each is costed for every day of the year, which gives the highest drug cost per patient. The low bound is the mean proportion of days covered over 12 months among Medicaid patients starting levodopa, 0.621; dopamine agonist starters had 0.546 in that study and 0.66 in a commercial and Medicare Advantage study. Those figures include patients who stopped treatment, whom a share already leaves out. One value is applied to every treatment.

  • “0.621 (0.322)”

    SourceJohnsrud et al. (2021)

  • “0.546 (0.343)”

    SourceJohnsrud et al. (2021)

  • “The mean (SD) PDC for the overall 642 patients was 0.66 (0.3). A total of 324 (50.5 %) of patients were PDC adherent to treatment as defined by PDC ≥0.80 (Table 5).”

    SourceFrazer et al. (2023)

• Market share

  Assumption

  Mix without Juvmo. The two segments share one mix, weighted by their base-case sizes: 27.1% of patients with Parkinson's disease are not on levodopa and 72.9% x 44% = 32.08% are on levodopa with motor fluctuations, which is 45.8% and 54.2% of eligible patients. Not on levodopa: 19% of patients receive no antiparkinsonian drug (100% - 81%) and 8.1% receive one without levodopa, so 29.9% of this segment is treated. Its classes follow first-line use other than levodopa (29.7% of treated patients): dopamine agonists 15.5%, MAO-B inhibitors 8.3%, amantadine 3.1%, which gives 15.6%, 8.4%, and 3.1% of the segment. On levodopa with motor fluctuations: dopamine agonists 32.4%, COMT inhibitors 22.1%, MAO-B inhibitors 21.2%, and amantadine 20.6% (patients with OFF episodes in a United States physician survey), and istradefylline 1.2% (3,610 Medicare Part D beneficiaries of 945,452 Medicare enrollees with Parkinson's disease is 0.38% of patients, divided by the 32.08% in this segment). Weighted: dopamine agonists 24.7%, MAO-B inhibitors 15.3%, COMT inhibitors 12%, amantadine 12.6%, istradefylline 0.6%. The survey counts a patient on two classes in both, so the share on none of the costed classes is understated. Mix with Juvmo. Uptake of 0.2%, 0.5%, 1% of eligible patients in years 1 to 3 is an assumption. Year 1 is anchored to the William Blair forecast of $70 million in 2027 sales: at $58,800 per patient-year that is 1,190 patient-years, or 0.17% of the 688,827 patients this funnel finds eligible in the United States (342,339,134 x 0.34% x 59.18%). The same forecast reaches $1.4 billion in 2040 (23,810 patient-years, 3.5%), and expects broad Medicare coverage no earlier than 2028, so years 2 and 3 rise toward that level. Juvmo draws its share from every class and from patients on none of them in proportion to their shares.

  • “The majority of PD patients (range, 81–82%) were prescribed at least 1 anti‐Parkinson drug each year.”

    SourceDahodwala et al. (2017)

  • “Of the treated patients, 90% were on l‐dopa therapy. This was followed by therapy with dopamine agonists (29–31%), MAOB inhibitors (9–11%), amantadine (7–8%), COMTIs (6–8%), and anticholinergics (5–6%) (Table 2).”

    SourceDahodwala et al. (2017)

  • “Of the 49,737 (72.6%) patients whose first treatment was observed during follow-up, 70.3% were prescribed levodopa/combination therapy, making it by far the most commonly used treatment class.”

    SourceHoughton et al. (2019)

  • “First-line use of monotherapy MAO-Bi was reported in 8.3% of patients and first-line use of amantadine was 3.1%.”

    SourceHoughton et al. (2019)

  • “7,729”

    SourceHoughton et al. (2019)

  • “104 (32.4)”

    SourceThach et al. (2021a)

  • “71 (22.1)”

    SourceThach et al. (2021a)

  • “68 (21.2)”

    SourceThach et al. (2021a)

  • “66 (20.6)”

    SourceThach et al. (2021a)

  • Brnd_Name Nourianz, Mftr_Name Overall: Tot_Benes_2024 3610

    SourceCenters for Medicare and Medicaid Services Part D Spending by Drug (2026)

  • Exhibit A 1, Insurance: Medicare: 945,452 persons estimated to have Parkinson's disease

    SourceThe Lewin Group (2026)

  • “Phipps projects $8 million in 2026 sales and $70 million in 2027, with a European launch assumed in 2028.”

    SourceBenzinga (2026)

  • “Overall, we believe the Juvmo approval adds to an important Parkinson’s disease franchise for the company (we estimate sales of $1.4 billion in 2040)…”

    SourceBenzinga (2026)

  • “While AbbVie expects Juvmo to eventually achieve broad access, Phipps expects coverage to build gradually, with broad Medicare coverage unlikely until 2028.”

    SourceBenzinga (2026)

  • “To get to the nub of your question, we do see that the ramp will be modest at first, and I'll tell you why. It's not the profile of the medication. It's largely because based on the timing of the approval, we will not be immediately added into the Medicare formularies.”

    SourceAbbVie earnings call transcript (2026)

  • “Evaluating tavapadon as a direct alternative to first-line oral levodopa may not reflect likely treatment patterns. As tavapadon enters the market, it is unlikely to displace levodopa as first-line therapy.”

    SourceAbbVie comments to ICER (2026)

  • “To size the first-line candidate population, we multiplied the US population averaged over the next five years (342,339,134)”

    SourceICER evidence report (2026)

Methods and limitations

Methods

• The population is prevalent: members with diagnosed Parkinson's disease are a stock, and each patient on a treatment is costed for the 12 months of each model year. The stock is held constant over the 3 years.
• Two segments are eligible, following the populations in which efficacy was established: adults not receiving levodopa, and adults receiving levodopa who have motor fluctuations.
• The two segments share one treatment mix, weighted by their base-case sizes (45.8% not on levodopa, 54.2% on levodopa with motor fluctuations). A change to a funnel input changes the number of eligible patients and leaves the mix as entered.
• Juvmo draws its share from every comparator class and from patients on none of them in proportion to their shares, so each loses the same fraction of its patients.
• A drug class is costed as a basket of its agents at the dose stated for each input, weighted by Medicare Part D beneficiaries in 2024, or for dopamine agonists by the MarketScan 2024 shares ICER reports.
• Costs are drug acquisition costs before rebates, member cost sharing, and dispensing fees, at 2026 prices in every year, undiscounted. Levodopa is left out of both scenarios: patients in the levodopa segment receive it with or without Juvmo.
• A year is costed as 365.25 days, so a 30-day supply is dispensed 12.175 times.

Limitations

• AbbVie has published no price statement. The price is the list price reported by one analyst and by ICER's public meeting slides; a rebate lowers the budget impact in proportion.
• Uptake is an assumption anchored to one analyst's sales forecast. ICER assumed that 20% of eligible patients start treatment each year, which is shown as a scenario.
• Class use among patients with motor fluctuations comes from a physician-reported survey that counts a patient on two classes in both. Medicare claims report lower use at levodopa initiation, for example dopamine agonists in 6.6% to 43.8% of patients across levodopa dose groups and formulations.
• Class use among patients not on levodopa is inferred from first-line treatment in newly diagnosed patients, and 9.4% of first-line use other than levodopa (anticholinergics and other drugs) is not costed.
• Pricing by strength and for the 40-day titration pack is not public. One price per 30-day supply is applied from the first day of treatment.
• Adverse event, monitoring, and other medical costs are not included. The trials compared Juvmo with placebo, so no estimate of a difference from another dopamine agonist exists.
• Incidence, mortality, and movement between segments as Parkinson's disease progresses are not modeled; a patient who stops Juvmo is outside its share.
• The baskets weight agents by Medicare Part D beneficiaries for all indications, which for generic amantadine include use outside Parkinson's disease.