The Cost Challenge: Why Patients Need Your Help With Droxidopa

Droxidopa (brand name Northera) is one of only two FDA-approved treatments for neurogenic orthostatic hypotension (nOH), yet its cost can be a significant barrier to adherence. Brand-name Northera carries a retail price of approximately $2,721 for 90 capsules, and even with insurance, many patients face high specialty tier copays that can reach hundreds of dollars per fill.

The good news for providers and patients alike: generic Droxidopa is now available and can cost as little as $36.90 with a GoodRx coupon. Combined with manufacturer programs, patient assistance, and strategic prescribing, there are multiple pathways to make this medication affordable. This guide covers every tool available to help your patients access Droxidopa without financial hardship.

Generic Droxidopa: The Single Biggest Cost Saver

The most impactful step you can take is prescribing generic Droxidopa when clinically appropriate. Generic capsules are available from multiple manufacturers in all three strengths (100mg, 200mg, and 300mg) and are FDA-approved as therapeutically equivalent to Northera.

Key pricing benchmarks for generic Droxidopa:

• GoodRx coupon price: As low as $36.90 for 90 capsules
• GoodRx Gold price: Approximately $67.17
• SingleCare price: Approximately $72.04 for 90 100mg capsules
• Cash price without coupons: Varies widely by pharmacy — always recommend patients compare

When writing prescriptions, allow generic substitution unless there is a specific clinical reason to require brand-name Northera. Most patients will see a cost reduction of over 95% by switching to generic.

Discount Coupon Cards and Programs

For patients paying cash or facing high copays, prescription discount cards can provide substantial savings on generic Droxidopa. Recommend that patients compare prices across multiple platforms:

• GoodRx — Consistently offers some of the lowest prices for generic Droxidopa
• SingleCare — Another reliable option with competitive pricing
• RxSaver — Compares prices across local pharmacies
• Optum Perks — May offer additional savings depending on pharmacy
• BuzzRx, ScriptSave WellRx, America's Pharmacy — Additional options worth checking

Important note for providers: coupon cards cannot be used with government insurance (Medicare, Medicaid, Tricare). For those patients, see the patient assistance program section below.

Manufacturer Copay Assistance: Northera Commercial Copay Program

Lundbeck offers the Northera Commercial Copay Assistance Program for eligible commercially insured patients who are prescribed brand-name Northera. Key details:

• Eligibility: Commercially insured patients with a valid Northera prescription
• Not eligible: Patients on Medicare, Medicaid, or other government insurance
• How to enroll: Patients can visit northera.com/patient-support or call the Northera support line

If your patient requires brand-name Northera (for example, due to a documented adverse reaction to a generic formulation), this program can significantly reduce their out-of-pocket costs.

Patient Assistance Programs (PAPs) for Uninsured and Underinsured Patients

For patients who are uninsured, underinsured, or on government insurance with high out-of-pocket costs, patient assistance programs may provide Droxidopa at no cost or significantly reduced cost:

• NeedyMeds (needymeds.org) — Comprehensive database of patient assistance programs, including those covering Droxidopa
• RxAssist (rxassist.org) — Another resource for finding PAPs by medication
• RxHope (rxhope.com) — Connects patients with manufacturer and foundation assistance programs

As the prescribing provider, you may need to complete paperwork or provide documentation of medical necessity for these programs. Having your office staff familiar with the application process can save significant time.

Prior Authorization: Strategies for Faster Approval

Most insurance plans require prior authorization (PA) for Droxidopa, whether brand or generic. A denied or delayed PA is one of the most common reasons patients go without their medication. Here's how to streamline the process:

Documentation Checklist

Include the following in every PA submission:

1. Confirmed nOH diagnosis — Document orthostatic vital signs (blood pressure drop of ≥20mmHg systolic or ≥10mmHg diastolic within 3 minutes of standing)
2. Underlying condition — Parkinson's disease, MSA, or pure autonomic failure diagnosis
3. Failed alternatives — Document prior trials of Midodrine, Fludrocortisone, or non-pharmacological interventions and why they were insufficient
4. Functional impact — Describe how nOH affects the patient's daily life, fall risk, and independence
5. Supine hypertension monitoring plan — Show that you have a plan to manage the boxed warning

Appeal Strategies

If the initial PA is denied:

• Peer-to-peer review: Request a conversation with the insurance company's medical director
• Letter of medical necessity: Provide detailed clinical justification including relevant literature
• Document step therapy failure: If the denial is based on step therapy requirements, document why alternatives failed or are contraindicated

Specialty vs. Retail Pharmacy: Guiding Your Patients

Where you send the prescription can significantly affect both cost and access:

• Specialty pharmacies — Often required for brand-name Northera; may have higher costs but better access to the drug and support services
• Retail pharmacies — Generic Droxidopa may be available at retail pharmacies like CVS, Walgreens, and Walmart at lower prices, especially with coupon cards
• Mail-order pharmacies — Often offer 90-day supplies at lower per-unit costs

When possible, direct patients to the pharmacy that offers the best combination of availability and price. Use MedFinder for Providers to help patients check real-time pharmacy stock.

Addressing Shortage-Related Cost Increases

During Droxidopa shortage periods, limited supply can drive up costs at some pharmacies. Strategies for these situations:

• Check multiple pharmacies — Prices and availability can vary significantly between locations, even within the same chain
• Consider dose optimization — Ensure the patient is on the minimum effective dose to stretch supply
• Contact Lundbeck directly — The manufacturer may have information about expected restocking timelines
• Have a backup plan — Discuss alternative treatments that can bridge gaps in Droxidopa availability

For the latest supply information, see our Droxidopa shortage update or the provider's guide to finding Droxidopa in stock.

Workflow Integration: Making Cost Conversations Routine

Integrating cost discussions into your clinical workflow ensures no patient falls through the cracks:

1. At prescribing: Default to generic Droxidopa with substitution allowed
2. At the point of PA submission: Include all required documentation upfront to minimize denials
3. At first fill: Ask patients about their actual out-of-pocket cost and adjust strategy if needed
4. At follow-up visits: Check if cost is affecting adherence — patients may not volunteer this information
5. Designate a staff member — Having one team member become the "Droxidopa access expert" streamlines the process

Quick Reference: Savings Options by Patient Type

• Commercially insured (brand): Northera Copay Assistance Program + PA support
• Commercially insured (generic): Coupon cards (GoodRx, SingleCare) if copay exceeds coupon price
• Medicare: Patient assistance programs (NeedyMeds, RxAssist) + Extra Help/LIS eligibility check
• Medicaid: Should be covered with PA; if not, contact state Medicaid for formulary exception
• Uninsured: Generic + coupon cards ($36.90+) or PAP enrollment for free medication

For patient-facing savings information, direct your patients to our guide on how to save money on Droxidopa. For additional provider resources on Droxidopa prescribing, including dosing guidelines, side effect management, and drug interactions, explore our full Droxidopa resource library at medfinder.com/providers.