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Specialty Pharmacy Services

Droxidopa (Northera)

Oral Capsule · Three Times Daily

Droxidopa (Northera) is a specialty medication used to reduce dizziness, lightheadedness, and near-fainting caused by neurogenic orthostatic hypotension. Accord Specialty Pharmacy provides droxidopa with prior authorization support, copay assistance coordination, and doorstep delivery.

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Drug at a Glance

  • Drug Class Norepinephrine Precursor (Prodrug)
  • Generic Name Droxidopa
  • Brand Name Northera®
  • Route Oral capsule, three times daily
  • Manufacturer Lundbeck (brand Northera) / multiple generics

Clinically Reviewed By · Accord Clinical Team, PharmD, RPh

Droxidopa (Northera) at a Glance

Feature Droxidopa (Northera)
Generic Name Droxidopa
Brand Name Northera®
Drug Class Norepinephrine Precursor (Prodrug)
FDA Approved For Symptomatic neurogenic orthostatic hypotension (nOH)
FDA Approved (Year) 2014
Dosage Form Oral capsule, three times daily; last dose 3+ hours before bedtime
Available Generic Yes
Specialty Pharmacy Required Often required by insurance
Prior Authorization Frequently required
Copay Assistance Available Yes, for eligible commercially insured patients
Home Delivery Available through Accord Specialty Pharmacy

FDA-Approved Uses

What Droxidopa (Northera) Is Used For

Droxidopa is approved for the treatment of symptomatic neurogenic orthostatic hypotension (nOH) in adults — specifically when nOH is caused by one of the following underlying conditions.2

Parkinson's Disease

PD — NEUROGENIC OH

Parkinson's disease can disrupt the autonomic nervous system as it progresses, reducing the body's ability to regulate blood pressure when standing. Many patients with Parkinson's experience neurogenic orthostatic hypotension as the disease advances, increasing the risk of falls and limiting daily activity.2,3

  • Symptomatic nOH caused by Parkinson's disease
  • Dizziness, lightheadedness, or near-fainting on standing

Multiple System Atrophy

MSA — NEUROGENIC OH

Multiple system atrophy is a rare, progressive neurological disorder that affects both movement and the autonomic nervous system. Blood pressure dysregulation upon standing is a hallmark feature of MSA and often one of its earliest and most disabling symptoms.1,2

  • Symptomatic nOH caused by MSA
  • Often a prominent early feature of the disease

Pure Autonomic Failure

PAF — NEUROGENIC OH

Pure autonomic failure is a neurodegenerative condition in which the autonomic nervous system progressively fails to regulate blood pressure and other involuntary functions. Unlike Parkinson's or MSA, PAF does not typically affect movement. Frequent, severe drops in blood pressure upon standing are the primary disability.1,2

  • Symptomatic nOH caused by pure autonomic failure
  • Severe postural blood pressure drops without motor involvement

Other Autonomic Conditions

DBH DEFICIENCY · NON-DIABETIC NEUROPATHY

Droxidopa is also approved for nOH caused by dopamine beta-hydroxylase deficiency, a rare genetic condition in which the body cannot produce adequate norepinephrine, and for nOH resulting from non-diabetic autonomic neuropathy, where nerve damage disrupts blood pressure regulation.2

  • Dopamine beta-hydroxylase (DBH) deficiency
  • Non-diabetic autonomic neuropathy

Your prescriber is the right person to determine whether droxidopa is appropriate for your specific condition and clinical situation. Learn more about orthostatic hypotension from NINDS ↗, or read about Neurology specialty pharmacy services →

What Is Droxidopa (Northera)?

For patients with certain neurological conditions, standing up can cause blood pressure to drop suddenly, triggering dizziness, lightheadedness, or a feeling of nearly blacking out. This experience is neurogenic orthostatic hypotension (nOH), and it can significantly limit daily activity. Droxidopa (Northera) is designed to help manage these symptoms by supporting the body's ability to maintain blood pressure when changing position.1

Droxidopa works as a precursor to norepinephrine, a signaling molecule that helps blood vessels constrict to keep blood pressure stable when standing. The body converts droxidopa into norepinephrine, helping restore some of the blood pressure regulation that is disrupted in patients with nOH.2 Treatment requires careful dose adjustment, and your prescriber will titrate the dose over time to find the level that provides the best symptom relief for your situation.

One important dosing instruction: the last dose of the day should be taken at least three hours before bedtime. Because droxidopa raises blood pressure, taking it too close to sleep can cause supine hypertension, a rise in blood pressure while lying down that carries cardiovascular risk.2 Accord manages the coordination between your prescriber, your insurance plan, and the patient support programs that help make treatment accessible. Learn how Accord supports patients →

Droxidopa Side Effects and What to Watch For

Like all specialty medications, droxidopa can cause side effects. Your prescriber will review what to expect before you begin treatment, and ongoing monitoring is an important part of droxidopa therapy.

Droxidopa carries an FDA Boxed Warning, the agency's most serious safety warning, for supine hypertension — a rise in blood pressure that can occur when lying down, particularly if a dose is taken too close to bedtime. This is why the last dose of the day should always be taken at least three hours before sleep, and why elevating the head of the bed is a standard precaution during treatment.2 Blood pressure is monitored before starting treatment and regularly throughout therapy. If anything concerns you while taking droxidopa, call Accord's pharmacy team at 1-855-222-6730.

Most Common

Frequently Reported2

  • Headache
  • Dizziness
  • Nausea
  • Elevated blood pressure
  • Fatigue
FDA Boxed Warning

Supine Hypertension2

  • Droxidopa carries an FDA Boxed Warning, the agency's most serious warning category, for supine hypertension — a rise in blood pressure while lying down that can occur if a dose is taken too close to bedtime
  • Take the last dose of the day at least three hours before bedtime
  • Elevating the head of the bed during sleep helps reduce this risk
  • Blood pressure is monitored before starting treatment and regularly throughout, particularly when the dose is being adjusted
Monitoring Required

Neuroleptic Malignant Syndrome2

  • Postmarketing reports describe a symptom complex resembling neuroleptic malignant syndrome (NMS) in patients taking droxidopa
  • Symptoms include high fever, muscle stiffness, altered mental status, and abnormal movements — seek emergency care immediately if these occur
  • Risk appears highest when the droxidopa dose is changed, or when concomitant levodopa (for Parkinson's disease) is reduced abruptly or discontinued, especially in patients also taking antipsychotic medications
  • Inform your prescriber of all medications you take, including any changes to your Parkinson's medications

Prior Authorization for Droxidopa (Northera)

Most insurance plans require prior authorization before covering droxidopa. Prior authorization is a process where your prescriber submits clinical documentation confirming that droxidopa is medically necessary for your condition. For droxidopa, this typically includes documentation of your underlying diagnosis, your nOH symptoms, and prior treatments or interventions that have been tried.

When Accord receives your referral, we contact your prescriber's office to gather what the insurance plan requires, submit the prior authorization request, and follow up proactively until a decision is reached. If your plan issues a denial, we work alongside your prescriber to prepare a formal appeal with the additional documentation needed to support your case. Information for prescribers →

Prior Authorization Process

1

Documentation

We request diagnosis records, nOH symptom documentation, and prior treatment history from your prescriber

2

PA Submission

Prior authorization submitted to your insurance plan with full clinical documentation

3

Plan Decision

Approval issued, or denial received — timelines vary by payer

4

Appeal if Denied

We build a formal appeal with your prescriber to support your case

Note on appeals: A denial is not necessarily final. Many initially denied requests for droxidopa are approved on formal appeal. Our team manages this process alongside your prescriber at no additional burden to your care team.

Droxidopa Cost and Northera Financial Assistance

Droxidopa cost and Northera cost can be significant before assistance programs are applied. What you actually pay depends on your coverage and which programs you qualify for. Our team works through all of that with you before your first fill.

Commercially Insured — Brand

Northera Commercial Copay Assistance Program

$10 as low as, per 30-day supply, for eligible patients

Lundbeck's copay assistance program reduces out-of-pocket costs to as little as $10 per 30-day supply for eligible commercially insured patients age 17 and older. For information and enrollment, call Northera Patient Support at 1-855-820-6768 or visit northera.com/patient-support. Not available for uninsured patients, Medicare, Medicaid, or other government insurance.4

Commercially Insured — Generic

Generic Droxidopa

Lower cost option for eligible patients

Generic droxidopa is FDA-approved and available through specialty pharmacies from multiple manufacturers. It contains the same active ingredient as brand Northera. Manufacturer copay programs apply to brand Northera only. Our team can help evaluate which option fits your coverage.5

Uninsured or Underinsured

Lundbeck Patient Assistance Program

$0 for eligible uninsured or underinsured patients

Lundbeck offers a patient assistance program for eligible uninsured or underinsured patients who meet income guidelines. Contact Northera Patient Support at 1-855-820-6768 to discuss eligibility and the application process.4

Medicare

Part D OOP Cap + Independent Foundations

$2,100 annual Part D out-of-pocket maximum (2026)

Manufacturer copay programs are not available for Medicare patients. Medicare Part D out-of-pocket costs are capped at $2,100 per year as of 2026. Independent foundation grants may provide additional support. Our team can help identify what applies to your situation.

Have questions about your specific coverage? Call 1-855-222-6730 or contact us online. Our team reviews your coverage and helps connect you to every program you may qualify for.

Getting Started

What to Expect with Accord

01

Referral Sent

Your prescriber sends a referral to Accord by fax or online referral form.

02

Insurance Verified

We confirm your coverage, benefits, and any cost-sharing requirements.

03

Prior Authorization

We submit clinical documentation and manage the PA process on your behalf.

04

Financial Assistance

We identify programs that may fit your situation and help connect you to the right resources.

05

Doorstep Delivery

Your medication ships directly to your door in states where Accord is licensed.

Have Questions About Droxidopa?

Ask a Specialty Pharmacist

Common Questions About Droxidopa (Northera)

Does Accord Specialty Pharmacy carry droxidopa (Northera)?

Yes. Accord is a licensed specialty pharmacy that dispenses both brand Northera and generic droxidopa. We manage prior authorization, financial assistance coordination, and doorstep delivery in states where Accord holds an active pharmacy license.

How do I transfer my droxidopa prescription to Accord?

Your prescriber can send a referral directly to Accord using our referral form, or by faxing to 386-456-3000. You can also call us at 1-855-222-6730 and our team will walk you through the process.

How long does prior authorization take for droxidopa?

Timelines vary by insurance plan and depend in part on the documentation your prescriber submits. Our team begins working on your prior authorization as soon as we receive your referral and follows up proactively. We keep both you and your prescriber updated throughout.

What if my insurance denies droxidopa?

A denial is not necessarily final. Our team works with your prescriber to submit a formal appeal with the additional documentation needed to support your case. Many initially denied requests are approved on appeal.

Is there a generic version of Northera?

Yes — generic droxidopa is FDA-approved and available through specialty pharmacies from multiple manufacturers. It contains the same active ingredient as brand Northera and must meet FDA bioequivalence standards.5 For some patients, the generic may offer meaningful cost savings. Call us at 1-855-222-6730 to discuss your options.

Is Northera a controlled substance?

No. Northera (droxidopa) is not a controlled substance. It is a prescription specialty medication that requires careful dose titration and regular monitoring, but it is not scheduled under the Controlled Substances Act. If you have questions about your prescription or what to expect from treatment, our pharmacy team is available at 1-855-222-6730.

Why does my prescriber periodically check whether droxidopa is still working?

According to the FDA-approved prescribing information, droxidopa's effectiveness beyond 2 weeks of treatment has not been formally established in clinical trials, so continued benefit needs to be assessed periodically rather than assumed.2 Your prescriber will evaluate how well it is managing your symptoms on an ongoing basis to confirm it is still providing meaningful benefit for you specifically. If you have questions about your treatment plan between appointments, our pharmacy team can be reached at 1-855-222-6730.

How is my droxidopa dose determined and adjusted?

Most patients start at a low dose taken three times daily, and your prescriber increases it in steps based on your blood pressure and symptom response, up to a maximum dose.2 This titration process can take some time, and everyone's starting dose and target dose are different. Do not adjust your dose on your own — always follow your prescriber's instructions, and call our pharmacists at 1-855-222-6730 if you have questions about your specific dosing schedule.

What should I do if I miss a dose of droxidopa?

If you miss a dose, take it as soon as you remember, unless it is close to your next scheduled dose or within three hours of bedtime, in which case skip it and resume your regular schedule with the next dose. Do not double up to make up for a missed dose. If you are unsure what to do, call our pharmacists at 1-855-222-6730 or check with your prescriber.

For Patients

Ready to Get Started?

Our team coordinates everything — insurance verification, prior authorization, financial assistance, and delivery. Call us or ask your prescriber to send a referral, and we take it from there.

Call 1-855-222-6730

For Prescribers

Refer a Patient to Accord

Download the droxidopa referral form, complete all sections, and fax to 386-456-3000. We confirm receipt within one business day and manage prior authorization on your behalf.

Download Referral Form

Explore More

Neurology Specialty pharmacy services for neurological conditions For Patients How Accord supports your specialty medication journey For Providers Referral process, PA support, and prescriber resources Referral Forms Download and fax to start the referral process
References (5)
  1. National Institute of Neurological Disorders and Stroke. Orthostatic Hypotension. National Institutes of Health. ninds.nih.gov
  2. Northera (droxidopa) Prescribing Information. Lundbeck NA Ltd. U.S. Food and Drug Administration. accessdata.fda.gov
  3. National Institute of Neurological Disorders and Stroke. Parkinson's Disease. National Institutes of Health. ninds.nih.gov
  4. Lundbeck. Northera Patient Support — Copay Assistance and Financial Programs. northera.com
  5. Drugs.com. Generic Northera (droxidopa) Availability. drugs.com
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