Cost of Caplyta in 2025: Discounts and Additional Benefits
Caplyta, a brand-name drug, is used to treat certain mental health conditions. The cost of Caplyta can vary significantly depending on various factors, primarily insurance coverage and related aspects.
Insurance Plan Benefits
Your out-of-pocket cost for Caplyta depends on the specifics of your insurance plan, such as copay amounts or coinsurance percentages. Different plans have different formularies and tier assignments, which impact the price.
Drug Tier
Caplyta is classified as a tier 5 specialty drug, which typically means higher cost-sharing than lower tiers. Specialty drugs often require higher coinsurance (around 33%) or copays and sometimes prior authorization.
Medicare Part D
For those with Medicare Part D coverage, Caplyta may be covered but usually at a higher tier (tier 5). Part D plans have an annual out-of-pocket limit (around $2,000 in 2025), which caps your maximum spending on drugs like Caplyta.
Dosage and Quantity
The prescribed dosage and number of capsules per bottle affect the total price. The wholesale price per capsule is approximately $57, or $1,709.94 per bottle, but insurance and dosage can reduce what you pay.
Pharmacy Choice
Where you fill your prescription (retail vs mail order) and your plan's pharmacy network can affect costs and co-insurance rates.
Cost Savings Programs
Manufacturer coupons or assistance programs may reduce your cost, but such coupons cannot be combined with insurance benefits.
Prior Authorization
Some plans require prior authorization before covering Caplyta, which can affect access and timing, indirectly affecting costs.
Caplyta Savings Card
A program called Caplyta Savings Card is available for Caplyta, offering potential support for individuals. To learn more and check eligibility, text "CAPLYTA" TO 26789, call 800-639-4047, or visit the program website.
It's essential to consult your doctor or another healthcare professional before taking any medication, including Caplyta. To find out the exact cost of Caplyta, consult with your doctor, pharmacist, or insurance provider. If you don't have health insurance, consult with your doctor or pharmacist for potential online pharmacy options.
Remember, the drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Always consult your doctor or another healthcare professional before taking any medication.
For more information about drug assistance programs, ways to maximize insurance coverage, and links to savings cards and other services, visit the Medicine Assistance Tool and NeedyMeds websites. If you don't have health insurance or your insurance policy doesn't cover Caplyta, check for Optum Perks coupons that may lower your cost of Caplyta without insurance.
[1] GoodRx. (2022). Caplyta Price, Coupons & Savings. Retrieved from https://www.goodrx.com/caplyta
[2] Caplyta. (n.d.). Caplyta Savings Card. Retrieved from https://www.caplyta.com/patients/savings-card
[3] RxSaver. (2022). Caplyta Cost, Coupons & Savings. Retrieved from https://www.rxsaver.com/caplyta
[4] Medicare.gov. (2022). Medicare Prescription Drug Plans. Retrieved from https://www.medicare.gov/find-a-plan/questions/drug-coverage
[5] Healthcare.gov. (2022). How Medicare Part D works. Retrieved from https://www.healthcare.gov/medicare-parts-a-b-and-d/how-medicare-part-d-works/
