Caplyta cost without insurance (approximate)<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n\n\nDose<\/b><\/td>\n Retail price<\/b><\/td>\n Cost with SingleCare coupon<\/b><\/td>\n<\/tr>\n\n30, 42 mg capsules (30-day supply)<\/b><\/td>\n $2,312<\/td>\n $1,718<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nWhy is Caplyta so expensive?<\/h2>\n
Caplyta<\/a> is so expensive because it\u2019s a relatively new drug, according to Archana Jhawar<\/a>, 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<\/a> and as an adjunctive therapy for major depressive disorder (MDD).<\/p>\nWhy does Caplyta\u2019s newness make it cost so much? In part because it is a brand-name drug without an available generic version. Its patents<\/a> and other forms of market exclusivity limit when generic versions can enter the market, usually for about 20 years.<\/p>\n\u201cSince there is only one manufacturer making the medication, there is no market competition to encourage lower medication costs,\u201d Dr. Jhawar explains.<\/p>\n
There\u2019s another piece of the high-cost puzzle to know here, too, says Zishan Khan, MD<\/a>, a Dallas-based board-certified psychiatrist: \u201cMany people don\u2019t take into account that the list price also reflects the broader costs associated with drug development, clinical trials, regulatory approval, and marketing.\u201d<\/p>\nHow to lower the cost of Caplyta<\/h2>\n
There are several ways to save money on Caplyta<\/a>, 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.<\/p>\nUse a free SingleCare coupon<\/h3>\n
A free SingleCare prescription savings card<\/a> 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\u2019t combine the two for added savings. You have to choose to fill your prescription using either the coupon or<\/i> insurance. You can compare pharmacy prices for Caplyta here<\/a> by entering your zip code to find the lowest cost in your area.<\/p>\n\t\t\t\n\t\t\t\tSave up to 80% on Caplyta with SingleCare<\/p>\n\t\t\t\t
Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t\t
\n\t\t\t\t\t\n\t\t\t\t\t\tCaplyta 42 mg (30 capsule)\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t23666 - Hampton, VA\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\n\t\t\t![\"Kroger](\"https:\/\/images.singlecare.com\/content\/images\/pharmacy\/logo-color-kroger.svg\")
\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t$1717.95![\"Harris](\"https:\/\/images.singlecare.com\/content\/images\/pharmacy\/logo-color-harristeeter.svg\")
\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t$1717.95Apply for Johnson & Johnson’s Caplyta Savings Card<\/h3>\n
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\u2019t help fully uninsured people or people with coverage from federal or state health programs such as Medicare, Medicaid, or Tricare.<\/p>\n
Apply for Johnson & Johnson\u2019s patient assistance program<\/h3>\n
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\u2019ll 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.<\/p>\n
Ask about insurance coverage and prior authorization<\/h3>\n
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\u2019s office to get prior authorization<\/a> before filling your prescription.<\/p>\nThis 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<\/a> first. \u201cSome plans require documentation that a patient has tried and not benefited from (or could not tolerate) preferred atypical antipsychotics<\/a> before approving Caplyta,\u201d 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\u2019ll cover Caplyta.<\/p>\nHowever, Dr. Khan says this varies widely by insurer and plan, and that sometimes all that\u2019s 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.<\/p>\n
If you aren\u2019t sure whether you\u2019ll need prior authorization before taking Caplyta, you should check your insurance plan\u2019s formulary<\/a> or call the number on your insurance card to speak with a representative and confirm your coverage.<\/p>\nAre there cheaper alternatives to Caplyta?<\/h2>\n
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.<\/p>\n
Common brand-name alternatives to Caplyta include Latuda<\/a> and Vraylar<\/a>, 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).<\/p>\n
\n\n\n\nCaplyta alternatives cost comparison (without insurance)<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n\n\nMedication<\/b><\/td>\n Brand-name price for 30-day supply<\/b><\/td>\n Generic price for 30-day supply<\/b><\/td>\n<\/tr>\n\nLatuda<\/a> (lurasidone)<\/a><\/td>\n $1,871<\/td>\n $18<\/td>\n<\/tr>\n \nVraylar (cariprazine)<\/a><\/td>\n $2,139<\/td>\n No generic available<\/td>\n<\/tr>\n \nAbilify<\/a> (aripiprazole)<\/a><\/td>\n $890<\/td>\n $11<\/td>\n<\/tr>\n \nSeroquel<\/a> (quetiapine)<\/a><\/td>\n $257<\/td>\n $9<\/td>\n<\/tr>\n \nZyprexa<\/a> (olanzapine)<\/a><\/td>\n $639<\/td>\n $12<\/td>\n<\/tr>\n \nRisperdal (risperidone)<\/a><\/td>\n $336<\/td>\n $9<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nExpert takeaway<\/h2>\n
\u201cThe 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,\u201d notes Chad Shaffer, MD, a member of the SingleCare Medical Board,<\/p>\n
Frequently asked questions<\/h2>\nIs there a generic version of Caplyta?<\/h3>\n
No. Caplyta is a relatively new drug and is still protected by a patent preventing other manufacturers from making generic versions.<\/p>\n
Does Medicare cover Caplyta?<\/h3>\n
Why is Caplyta so expensive?<\/h2>\n
Caplyta<\/a> is so expensive because it\u2019s a relatively new drug, according to Archana Jhawar<\/a>, 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<\/a> and as an adjunctive therapy for major depressive disorder (MDD).<\/p>\n Why does Caplyta\u2019s newness make it cost so much? In part because it is a brand-name drug without an available generic version. Its patents<\/a> and other forms of market exclusivity limit when generic versions can enter the market, usually for about 20 years.<\/p>\n \u201cSince there is only one manufacturer making the medication, there is no market competition to encourage lower medication costs,\u201d Dr. Jhawar explains.<\/p>\n There\u2019s another piece of the high-cost puzzle to know here, too, says Zishan Khan, MD<\/a>, a Dallas-based board-certified psychiatrist: \u201cMany people don\u2019t take into account that the list price also reflects the broader costs associated with drug development, clinical trials, regulatory approval, and marketing.\u201d<\/p>\n There are several ways to save money on Caplyta<\/a>, 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.<\/p>\n A free SingleCare prescription savings card<\/a> 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\u2019t combine the two for added savings. You have to choose to fill your prescription using either the coupon or<\/i> insurance. You can compare pharmacy prices for Caplyta here<\/a> by entering your zip code to find the lowest cost in your area.<\/p>\n\t\t\t Save up to 80% on Caplyta with SingleCare<\/p>\n\t\t\t\t Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t\t 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\u2019t help fully uninsured people or people with coverage from federal or state health programs such as Medicare, Medicaid, or Tricare.<\/p>\n 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\u2019ll 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.<\/p>\n 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\u2019s office to get prior authorization<\/a> before filling your prescription.<\/p>\n 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<\/a> first. \u201cSome plans require documentation that a patient has tried and not benefited from (or could not tolerate) preferred atypical antipsychotics<\/a> before approving Caplyta,\u201d 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\u2019ll cover Caplyta.<\/p>\n However, Dr. Khan says this varies widely by insurer and plan, and that sometimes all that\u2019s 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.<\/p>\n If you aren\u2019t sure whether you\u2019ll need prior authorization before taking Caplyta, you should check your insurance plan\u2019s formulary<\/a> or call the number on your insurance card to speak with a representative and confirm your coverage.<\/p>\n 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.<\/p>\n Common brand-name alternatives to Caplyta include Latuda<\/a> and Vraylar<\/a>, 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).<\/p>\n \u201cThe 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,\u201d notes Chad Shaffer, MD, a member of the SingleCare Medical Board,<\/p>\n No. Caplyta is a relatively new drug and is still protected by a patent preventing other manufacturers from making generic versions.<\/p>\nHow to lower the cost of Caplyta<\/h2>\n
Use a free SingleCare coupon<\/h3>\n
\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\tApply for Johnson & Johnson’s Caplyta Savings Card<\/h3>\n
Apply for Johnson & Johnson\u2019s patient assistance program<\/h3>\n
Ask about insurance coverage and prior authorization<\/h3>\n
Are there cheaper alternatives to Caplyta?<\/h2>\n
\n\n
\n \n Caplyta alternatives cost comparison (without insurance)<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n\n
\n Medication<\/b><\/td>\n Brand-name price for 30-day supply<\/b><\/td>\n Generic price for 30-day supply<\/b><\/td>\n<\/tr>\n \n Latuda<\/a> (lurasidone)<\/a><\/td>\n $1,871<\/td>\n $18<\/td>\n<\/tr>\n \n Vraylar (cariprazine)<\/a><\/td>\n $2,139<\/td>\n No generic available<\/td>\n<\/tr>\n \n Abilify<\/a> (aripiprazole)<\/a><\/td>\n $890<\/td>\n $11<\/td>\n<\/tr>\n \n Seroquel<\/a> (quetiapine)<\/a><\/td>\n $257<\/td>\n $9<\/td>\n<\/tr>\n \n Zyprexa<\/a> (olanzapine)<\/a><\/td>\n $639<\/td>\n $12<\/td>\n<\/tr>\n \n Risperdal (risperidone)<\/a><\/td>\n $336<\/td>\n $9<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Expert takeaway<\/h2>\n
Frequently asked questions<\/h2>\n
Is there a generic version of Caplyta?<\/h3>\n
Does Medicare cover Caplyta?<\/h3>\n