How much does Caplyta cost without insurance?

In this article:

• Cost without insurance
• Why is it so expensive?
• How to save
• Caplyta alternatives
• FAQs

In this article

• Cost without insurance
• Why is it so expensive?
• How to save
• Caplyta alternatives
• FAQs

If your healthcare provider prescribed the atypical antipsychotic Caplyta (lumateperone) to treat your bipolar depression or schizophrenia, you might have wondered about the drug’s side effects, safety, and overall effectiveness. These are all important factors to consider, but so is the price: A 30-day supply of Caplyta can cost more than $2,300 without insurance. To make matters worse, there’s no less-expensive, generic alternative.

For people without insurance, affording Caplyta is often a serious barrier to taking it. Saving money on this medication means relying on savings cards, patient assistance programs, and prescription coupons like SingleCare. Here are your options for lowering the cost of Caplyta without insurance.

How much does Caplyta cost without insurance?

The retail price of Caplyta is about $2,310 for 30, 42 mg capsules, though the exact price will vary based on the pharmacy where you fill your prescription and your dose. Unfortunately, the cost of Caplyta is still generally high regardless of these other factors. Plus, there’s no generic alternative that provides an automatic cost savings.

Caplyta cost without insurance (approximate)
Dose	Retail price	Cost with SingleCare coupon
30, 42 mg capsules (30-day supply)	$2,312	$1,718

Why is Caplyta so expensive?

Caplyta is so expensive because it’s a relatively new drug, according to Archana Jhawar, Pharm.D., clinical assistant professor of pharmacy practice at the University of Illinois Chicago (UIC) Retzky College of Pharmacy. It was approved by the U.S. Food and Drug Administration (FDA) in 2019 for the treatment of schizophrenia, and later received FDA approvals for depressive episodes due to bipolar disorder and as an adjunctive therapy for major depressive disorder (MDD).

Why does Caplyta’s newness make it cost so much? In part because it is a brand-name drug without an available generic version. Its patents and other forms of market exclusivity limit when generic versions can enter the market, usually for about 20 years.

“Since there is only one manufacturer making the medication, there is no market competition to encourage lower medication costs,” Dr. Jhawar explains.

There’s another piece of the high-cost puzzle to know here, too, says Zishan Khan, MD, a Dallas-based board-certified psychiatrist: “Many people don’t take into account that the list price also reflects the broader costs associated with drug development, clinical trials, regulatory approval, and marketing.”

How to lower the cost of Caplyta

There are several ways to save money on Caplyta, though the options are different based on your insurance status. The only option that works regardless of income and insurance status is the SingleCare prescription discount coupon.

Use a free SingleCare coupon

A free SingleCare prescription savings card can bring Caplyta’s retail price down from $2,310 to around $1,669 at participating pharmacies. You can use the coupon no matter your insurance coverage, but keep in mind that you can’t combine the two for added savings. You have to choose to fill your prescription using either the coupon or insurance. You can compare pharmacy prices for Caplyta here by entering your zip code to find the lowest cost in your area.

Apply for Johnson & Johnson’s Caplyta Savings Card

If you have private commercial insurance, you may qualify for the Johnson & Johnson Caplyta Savings Card. This allows eligible patients to pay a small copay (or, in many cases, nothing at all) for a 30- or 90-day supply of Caplyta up to a certain maximum. However, this option is only for patients with commercial insurance, so it doesn’t help fully uninsured people or people with coverage from federal or state health programs such as Medicare, Medicaid, or Tricare.

Apply for Johnson & Johnson’s patient assistance program

If you are uninsured and meet certain eligibility requirements, you may be able to use the Johnson & Johnson patient assistance program to get free or low-cost Caplyta. After filling out an application providing proof of income, you may be enrolled in the program for up to one year at a time. (Beyond the first year, you’ll need to submit a new application and get re-approved). For anyone without insurance or who is struggling to afford their prescription, this may be a way to get low-cost access to Caplyta, as long as income guidelines are met.

Ask about insurance coverage and prior authorization

Caplyta is covered by many commercial health insurance plans and many Medicare Part D or Medicaid plans, but you should expect to work with your provider’s office to get prior authorization before filling your prescription.

This means your insurance company has to approve your medical need for Caplyta before covering it, and getting prior authorization for Caplyta often requires something called step therapy first. “Some plans require documentation that a patient has tried and not benefited from (or could not tolerate) preferred atypical antipsychotics before approving Caplyta,” says Dr. Khan. For example, some insurance plans require you to try several other less-expensive antipsychotic medications for schizophrenia or two other medications for bipolar depression before they’ll cover Caplyta.

However, Dr. Khan says this varies widely by insurer and plan, and that sometimes all that’s needed for prior authorization is an exception request from your provider because you have a clinically sound reason for needing Caplyta. This may be an option for people who have had significant side effects or contraindications with other drugs, or who are already taking Caplyta and doing well on it.

If you aren’t sure whether you’ll need prior authorization before taking Caplyta, you should check your insurance plan’s formulary or call the number on your insurance card to speak with a representative and confirm your coverage.

Are there cheaper alternatives to Caplyta?

Because Caplyta has no generic alternative, your healthcare provider may suggest another antipsychotic as part of your treatment plan. According to Dr. Khan, several medications may be appropriate for treatment of your symptoms, including aripiprazole, quetiapine, lurasidone, olanzapine, and risperidone; these are typically more affordable or easier to obtain through insurance, he says.

Common brand-name alternatives to Caplyta include Latuda and Vraylar, though these drugs can be expensive without insurance coverage, too. Like Caplyta, Vraylar is relatively new and does not have a generic alternative yet, but Latuda does have a generic version (which helps lower its cost significantly).

Caplyta alternatives cost comparison (without insurance)
Medication	Brand-name price for 30-day supply	Generic price for 30-day supply
Latuda (lurasidone)	$1,871	$18
Vraylar (cariprazine)	$2,139	No generic available
Abilify (aripiprazole)	$890	$11
Seroquel (quetiapine)	$257	$9
Zyprexa (olanzapine)	$639	$12
Risperdal (risperidone)	$336	$9

Expert takeaway

“The best argument in favor of Caplyta is its favorable side effect profile compared to other atypical antipsychotics, but its expense is the biggest hangup, making discount options even more pivotal,” notes Chad Shaffer, MD, a member of the SingleCare Medical Board,

Frequently asked questions

Is there a generic version of Caplyta?

No. Caplyta is a relatively new drug and is still protected by a patent preventing other manufacturers from making generic versions.

Does Medicare cover Caplyta?

Medicare typically covers Caplyta under Medicare Part D prescription drug plans or Medicare Advantage plans that include drug coverage, but you should always check your specific plan’s coverage before filling your prescription. If Caplyta is on the plan’s formulary, it may have a higher copay tier, meaning more out-of-pocket expense, compared to other atypical antipsychotics.

Can you use a SingleCare coupon and the Caplyta Savings Card at the same time?

No, you can’t use both the coupon and the manufacturer savings card at the same time. You need to choose one or the other.