Vyalev is a treatment for Parkinson’s that was the first U.S.-approved therapy to provide levodopa and carbidopa, the gold standard for Parkinson’s symptom relief, as a liquid that is delivered continuously under-the-skin. Unlike pills that you take throughout the day, Vyalev uses a pump device that you wear at all times, and only disconnect when you shower, bathe or swim. The medication is delivered continuously through the day and night. This, ideally, helps smooth out “off” times, especially during the night and early morning, when symptoms return because medication levels fluctuate.
Who is a candidate for Vyalev?
The medication aims to give more time throughout the day when symptoms are controlled (“on” time) and lessen ups and downs in symptoms (motor fluctuations) or extra movement (dyskinesia). If you experience a lot of time with symptoms (“off” time) or have motor fluctuations and/or dyskinesia despite taking medication frequently, or if you generally don’t have optimal symptom control on your current medication regimen, Vyalev may be an option.
How do you start Vyalev?
Your doctor prescribes the medication through a specialty pharmacy, which sends you the medication, pump and supplies. A nurse ambassador teaches you how to use the pump and administer medication. Your doctor calculates how much medication to give through the pump based on how much medication you’re currently taking. You may need two to three or more visits with your doctor in the days and weeks following initiation to find the best dosage and rate of administration.
What does the Vyalev pump look like?
The pump device is about the size of two stacked cell phones. It weighs less than a pound. You carry it in a waist belt, vest or similar case. The medication runs 24 hours a day, even when you are sleeping, but you temporarily disconnect it for showering, bathing or swimming.
How does the Vyalev system connect to the body?
A small needle is inserted just under the skin. The needle is removed, but a small tube (cannula) remains to infuse medication. You change the needle and tube each day, inserting in different skin areas to lessen the chance of nodules, or bumps.
The medication comes in prefilled, single-use syringes that you load in the pump. Medication must be refrigerated but can be left unrefrigerated (as for travel) for a one-time period of up to 28 days.
What are the side effects?
The main side effects are related to skin infusion areas. These locations could develop infection, redness, swelling, warmth or nodules. To lessen risks, make sure your hands and skin are clean and dry when starting or stopping medication and regularly switch infusion sites.
Is Vyalev covered by insurance?
In January 2026, Medicare defined its coverage of the treatment for the first time, setting clear rules to guide how doctors prescribe and how patients can access this Parkinson’s therapy. People who are transferring from a different infusion-based therapy, such as Duopa, as well as those who will be using an infusion therapy for the first time, are eligible as long as certain criteria are met. Patients interested in Vyalev should talk with their doctor about whether this therapy is appropriate for them and how Medicare coverage would apply. You can also use an online tool to view your Medicare coverage options.
Vyalev coverage also varies across commercial plans, so you will need to speak with your doctor and insurance policy provider to determine what is covered and whether you need pre-approval.
