Caplyta savings guide

In this article:

• How much does Caplyta cost?
• How to save money on Caplyta
• Is there a cheaper alternative to Caplyta?

In this article

• How much does Caplyta cost?
• How to save money on Caplyta
• Is there a cheaper alternative to Caplyta?

Caplyta (lumateperone) is a brand-name prescription antipsychotic that is FDA-approved to treat schizophrenia, bipolar depression, and major depressive disorder when used with antidepressants. Paying for a premium-priced prescription like Caplyta can add up quickly, especially if you’re uninsured or your insurance plan doesn’t cover it fully. Whether you’re newly prescribed or have been on it a while, understanding your options can help you avoid unnecessary costs. This guide walks through what Caplyta costs, ways to save with or without insurance coverage, and potential lower-cost alternatives to talk to your healthcare provider about. 

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How much does Caplyta cost?

The average retail price of Caplyta is $2,306 for 30, 42 mg capsules without insurance, or about $76 per daily capsule. What you actually pay can vary based on your insurance, pharmacy, and dosage prescribed. Without insurance coverage, the yearly cost could add up to $26,000.

According to the drug manufacturer, Johnson & Johnson, Caplyta is covered for about 90% of people with commercial insurance and more than 99% of eligible patients with Medicaid and Medicare Part D. However, coverage for Caplyta may not always be straightforward. Many plans may require prior authorization or step therapy first. For example, United Healthcare commercial plans cover Caplyta only with prior authorization and step therapy.

Caplyta is usually placed in the highest drug tiers. This means that, even when covered, you may pay higher out-of-pocket costs for Caplyta compared to other medications.

How to save money on Caplyta

If your health insurance plan doesn’t cover Caplyta, there are other ways to save on the medication. These include using coupons or discount cards, joining savings programs, and looking into patient assistance programs. 

1. Free Caplyta coupons

A SingleCare Caplyta coupon can save you over $600 per month on your prescription. With SingleCare, you could pay $1,669 for 30, 42 mg capsules of Caplyta at Kroger without using insurance. Costs vary by quantity, strength, form, and the pharmacy that fills your prescription. 

SingleCare coupons are easy to use, and you can use them at many major pharmacies across the country. You can also use the SingleCare app to save on the go. Members save even more, and it’s free to sign up.

2. Medicare or Medicaid coverage

People who have Medicare or Medicaid coverage may be able to save more on their Caplyta prescriptions. Those with Medicare Part D may be eligible for the low-income subsidy, Medicare Extra Help, for prescription drug coverage. Some people may qualify for Extra Help automatically, but others may have to apply through the Social Security Administration’s website. 

Your state may also have a State Pharmaceutical Assistance Program that may further help with Caplyta costs. People with Medicare Part D or, in some states, people with disabilities may be eligible for these programs. 

3. Caplyta savings card

Johnson & Johnson, the manufacturer of Caplyta, has a Caplyta savings program for people with private commercial insurance (not state or federal health plans). The Caplyta savings card is really a Caplyta copay card that can reduce your cost to as little as $0 for the first two 30-day fills, but maximum savings limits apply. You can find eligibility criteria on the manufacturer’s website.

4. Caplyta patient assistance program

Johnson & Johnson offers a patient assistance program for uninsured U.S. residents who meet the income eligibility requirements. It’s free to apply to the program, but you have to submit proof of income as part of the application process. People who qualify may receive Caplyta for up to 90 days. After that, they may be eligible to get Caplyta for free for up to a year. 

Is there a cheaper alternative to Caplyta?

Yes. Healthcare providers may prescribe Caplyta because it can be effective in some patients with relatively low side effects. Sharon Batista, MD, a psychiatrist specializing in mood disorders and the assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City, says, “These features make it attractive for patients concerned about metabolic effects, sedation, or tolerability. However, Caplyta remains a brand-only medication with no generic equivalent, which limits access due to high cost and inconsistent insurance coverage.” 

Healthcare providers may prescribe more affordable Caplyta alternatives based on someone’s specific clinical picture. Jaime Waarbroek, a psychiatric mental health nurse practitioner at Neuro Wellness Spa in Los Angeles, California, says, “I often start my patients on alternatives that show comparable efficacy based on trials at dramatically lower costs.” She mentions quetiapine, the generic version of Seroquel, as a common starting point for people with bipolar depression: “I typically start here as it’s the only other FDA-approved treatment for both bipolar I and II depression,” she shares.

However, quetiapine has side effects to be aware of. “Its sedative properties can be beneficial for patients with insomnia or agitation, but weight gain and metabolic risk are significant considerations,” Dr. Batista says.

Caplyta alternatives for bipolar depression

For people with bipolar depression who experience drowsiness on certain medications, Waarbroek considers lurasidone, the generic version of Latuda.  “I prescribe this when patients need to avoid sedation,” Dr. Batista says. Though lurasidone may be more costly than other generics, she says it’s still an alternative for “bipolar depression in patients for whom metabolic side effects are a concern.” 

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Caplyta alternatives for schizophrenia

For people with schizophrenia looking for alternatives to Caplyta, Waarbroek considers risperidone, which is the generic form of Risperdal, as her go-to for positive symptoms when cost is a concern. Although it is generally affordable, she emphasizes the need to monitor for extrapyramidal symptoms (EPS) and prolactin elevation. Extrapyramidal symptoms are nervous system-related symptoms that impact muscle control, causing involuntary or repetitive movements.

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Bottom line: You have options for affordable mental health treatment

If the cost of Caplyta is too high, reach out to your healthcare provider to discuss other options. They may be able to recommend another effective treatment that fits your budget, or they may help you apply for patient assistance programs. “The best practice when selecting an alternative includes weighing the patient’s psychiatric history, side effect vulnerability (particularly weight and metabolic changes), prior medication response, drug-drug interactions, and insurance or cost barriers,” Dr. Batista says. Managing your health shouldn’t be a financial burden. There are ways to get help. 

For example, using a SingleCare coupon can help make these options (and Caplyta itself) more affordable at participating pharmacies. SingleCare coupons are free, and many pharmacies accept them.