{"id":630449,"date":"2024-11-14T10:31:55","date_gmt":"2024-11-14T15:31:55","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630449"},"modified":"2026-01-13T17:11:28","modified_gmt":"2026-01-13T22:11:28","slug":"does-medicaid-cover-rexulti","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicaid-cover-rexulti\/","title":{"rendered":"Does Medicaid cover Rexulti?"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/rexulti\"><span style=\"font-weight: 400;\">Rexulti<\/span><\/a><span style=\"font-weight: 400;\"> (brexpiprazole) was initially approved by the Food and Drug Administration (FDA) in 2015 as a treatment for schizophrenia in adults and children 13 years and older and as an adjunctive therapy for major depressive disorder (MDD) in adults. Since then, it has also been approved to treat agitation associated with dementia due to Alzheimer&#8217;s disease. Rexulti acts on dopamine and serotonin, chemicals in the brain, to correct imbalances and ease the symptoms of schizophrenia and MDD. Although <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/rexulti\/what-is\"><span style=\"font-weight: 400;\">Rexulti<\/span><\/a><span style=\"font-weight: 400;\"> is effective, it is an expensive drug to make. For those relying on Medicaid, coverage for Rexulti can vary.\u00a0 <\/span><\/p>\n<h2 id=\"is-rexulti-covered-by-medicaid\"><span style=\"font-weight: 400;\">Is Rexulti covered by Medicaid?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In many states, Medicaid may cover Rexulti. Still, this coverage may come with certain restrictions. If Medicaid covers Rexulti in your state, there may be specific conditions you need to meet to receive coverage. These criteria can include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><b>Prior authorization<\/b><\/a><b>:<\/b><span style=\"font-weight: 400;\"> In some states, Medicaid may require<\/span> <span style=\"font-weight: 400;\">your healthcare provider to submit a request to Medicaid explaining why Rexulti is the best treatment option for you. The approval process can take time, so starting this process early can help get the medication sooner rather than later.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/blog\/step-therapy\/\"><b>Step therapy<\/b><\/a><b>:<\/b><span style=\"font-weight: 400;\"> Medicaid may require you to try other less expensive or more established medications before approving Rexulti.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">To determine if your state&#8217;s program covers Rexulti, check your state&#8217;s website or contact your local Medicaid office. Your healthcare provider or pharmacist can also help.<\/span><\/p>\n<h2 id=\"how-much-does-rexulti-cost\"><span style=\"font-weight: 400;\">How much does Rexulti cost?\u00a0<\/span><\/h2>\n<p><a href=\"https:\/\/www.singlecare.com\/blog\/rexulti-without-insurance\/\"><span style=\"font-weight: 400;\">Rexulti costs<\/span><\/a><span style=\"font-weight: 400;\"> $2,061 for 30, 1 mg tablets without insurance. Prices fluctuate, however, and they also vary by dosage and pharmacy.\u00a0<\/span><\/p>\n<h3 id=\"cost-of-rexulti-with-medicaid\"><span style=\"font-weight: 400;\">Cost of Rexulti with Medicaid\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The cost of Rexulti with Medicaid is about $2.88 per month on average, according to the manufacturer of Rexulti, <\/span><a href=\"https:\/\/www.rexulti.com\/savings-cost#\"><span style=\"font-weight: 400;\">Otsuka America Pharmaceutical Inc<\/span><\/a><span style=\"font-weight: 400;\">. You may pay more or less depending on your state of residence.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Each state Medicaid program has its own <\/span><a href=\"https:\/\/www.kff.org\/other\/state-indicator\/medicaid-preferred-drug-lists\/?currentTimeframe=0&amp;sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\"><span style=\"font-weight: 400;\">preferred drug list (PDL)<\/span><\/a><span style=\"font-weight: 400;\">, which is a list of outpatient drugs that states encourage healthcare providers to prescribe over others. States may charge higher copays or establish certain requirements for drugs that aren\u2019t on the PDL. Drugs are typically organized by tiers, with the lowest copays on tier 1 and the highest copays on tier 4. You can contact your state Medicaid program or your pharmacist to learn how much you can expect to pay for Rexulti.<\/span><\/p>\n<h2 id=\"ways-to-get-discounts-on-rexulti-without-medicaid\"><span style=\"font-weight: 400;\">Ways to get discounts on Rexulti without Medicaid\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you don&#8217;t have Medicaid or if your state doesn&#8217;t cover Rexulti, there are other ways to save. For example,<\/span> <span style=\"font-weight: 400;\">the <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">SingleCare prescription discount card<\/span><\/a><span style=\"font-weight: 400;\"> can help you save on Rexulti at thousands of participating pharmacies across the country. With a <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/rexulti\"><span style=\"font-weight: 400;\">Rexulti coupon<\/span><\/a><span style=\"font-weight: 400;\">, you could pay $1,471 instead of $2,061 for a one-month supply. Although anyone can use SingleCare coupons, you can\u2019t combine savings with Medicaid benefits.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You can also talk to your healthcare provider about <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/rexulti-alternatives\/\"><span style=\"font-weight: 400;\">Rexulti alternatives<\/span><\/a><span style=\"font-weight: 400;\">. Although there\u2019s no lower-cost <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/rexulti-generic\/\"><span style=\"font-weight: 400;\">generic version of Rexulti<\/span><\/a><span style=\"font-weight: 400;\"> yet, some Rexulti alternatives may have generic versions that are more affordable.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Keep in mind that beneficiaries who have both Medicaid and Medicare are considered dually eligible, so you may be able to apply for <\/span><a href=\"https:\/\/www.medicare.gov\/basics\/costs\/help\/drug-costs\"><span style=\"font-weight: 400;\">Medicare Extra Help<\/span><\/a><span style=\"font-weight: 400;\"> to lower the cost of Rexulti under Medicare Part D. Eligible beneficiaries could pay $12.15 for a one-month supply of this brand-name drug.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/rexulti-cost-with-medicare\/\"><b>How much does Rexulti cost with Medicare?<\/b><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Rexulti (brexpiprazole) was initially approved by the Food and Drug Administration (FDA) in 2015 as a treatment for schizophrenia in adults and children 13 years and older and as an adjunctive therapy for major depressive disorder (MDD) in adults. Since then, it has also been approved to treat agitation associated with dementia due to Alzheimer&#8217;s [&hellip;]<\/p>\n","protected":false},"author":149,"featured_media":630450,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[15103,16],"coauthors":[21032],"class_list":["post-630449","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-drug-pricing","tag-medicaid","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Is Rexuli covered by Medicaid?<\/title>\n<meta name=\"description\" content=\"Medicaid often covers Rexulti, but some state Medicaid programs charge higher copays for it than others.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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