Is Latuda covered by Medicare?

In this article:

• How much does Latuda cost?
• Does Medicare cover Latuda?
• Cost of Latuda with Medicare
• How to save on Latuda

In this article

• How much does Latuda cost?
• Does Medicare cover Latuda?
• Cost of Latuda with Medicare
• How to save on Latuda

Latuda (lurasidone) is a brand-name prescription drug that’s approved by the Food and Drug Administration (FDA) to treat schizophrenia as well as bipolar depression associated with bipolar I disorder. It’s also sometimes prescribed off-label to treat major depressive disorder and other mental health conditions. The price of Latuda can vary based on several factors, including your location, pharmacy, and insurance coverage. Fortunately, many Medicare Part D plans cover Latuda, but the extent of that coverage depends on your specific plan, as well as certain other factors. We’ll provide more details on Latuda’s Medicare coverage below. 

How much does Latuda cost?

As of the time this article was written, Latuda’s average price for 30, 40 milligram (mg) tablets is $1,859.

In 2019, the FDA approved a generic version of Latuda (lurasidone), which just became available in 2023. Generic drugs use the same active ingredient as their brand-name counterparts. The FDA requires them to be bioequivalent, and what’s more, they can be 80%–85% cheaper. 

Whether you get Latuda or its generic equivalent, the price can vary based on factors such as insurance coverage and the pharmacy you use. Because various pharmaceutical industry players—from manufacturers to wholesalers to pharmacies—help determine patient prices, different pharmacies and locations might have different rates.

Does Medicare cover Latuda?

In many cases, yes, Medicare will cover Latuda (or generic lurasidone) because it’s an important medication for treating serious mental health conditions. “A number of my patients report they do indeed have Medicare coverage for their Latuda prescriptions, but as with other forms of insurance, specific out-of-pocket amounts vary based on each person’s individualized plan,” says Abid Nazeer, MD, psychiatrist and chief resident at Symetria Recovery. 

For example, some plans might cover generic lurasidone or other brand-name antipsychotics instead. And when a plan does cover Latuda, it might not provide complete coverage. Depending on the copay, coinsurance, and deductible amounts, patients may still be responsible for part of the cost.

Plus, “prior authorization for this medication [may be] required because of the serious condition it seeks to remedy and the associated prescription cost,” Dr. Nazeer says. “Latuda is not prescribed without dedicated medical consideration and reasonable patient need (if other medicinal options are deemed insufficient).”

This is why “ensuring patients have the proper documentation is crucial,” says Sazan Sylejmani, Pharm.D. “Much like with Medicare coverage for medical beds, having a detailed prescription that clearly justifies the necessity of Latuda can sometimes aid in securing prior authorizations, which are often required for coverage.”

Usually, Medicare provides coverage when it’s prescribed to treat approved indications, specifically schizophrenia and bipolar disorder. However, some plans may also cover off-label uses as long as a drug is medically necessary in those situations. This means you may need prior authorization to take it for depression or other issues.

Is Latuda covered by Medicare Part B?

No. Medicare Part B covers a limited amount of prescription drugs and only in certain circumstances—such as when administered by a healthcare professional in an outpatient setting. Unfortunately, Latuda isn’t one of them. According to spending data from the Centers for Medicare and Medicaid Services, Medicare Part B plans have never spent money covering it. 

Is Latuda covered by Medicare Part D?

While Medicare Parts A and B don’t cover most prescription drugs, beneficiaries can add on a Part D plan to get some help with their medications. Medicare Advantage plans (Part C) usually include drug coverage, or you can add it as a standalone plan to Original Medicare. So, if you have Medicare coverage for Latuda, it’s through a Part D plan or Medicare Advantage Plan with drug coverage.

In 2022, Medicare Part D plans spent nearly $1.5 billion covering Latuda for 106,302 beneficiaries.

Cost of Latuda with Medicare

Even if your Medicare prescription drug plan covers Latuda, you still might be responsible for some costs, such as copays or coinsurance. “However, coverage and the associated out-of-pocket costs can greatly vary between different Part D plans,” Dr. Sylejmani says. “For instance, beneficiaries might face tiers in their plans, where Latuda is placed in a higher tier, leading to higher copayments or even coinsurance.”

Your costs may also be impacted by your current coverage phase—the deductible phase, initial phase, coverage gap, or catastrophic coverage phase.

The only way to know for sure is to check your plan’s formulary—a drug list that shows preferred and non-preferred drugs, as well as how they’re covered. 

How to save on Latuda

At one point, Latuda had a savings card that people with private health insurance could use to save money. But unfortunately, that program ended in July 2024. Insurance is one of the best ways to bring down your out-of-pocket expenses. But if your insurance or Medicare Part D policy doesn’t provide affordable coverage for Latuda, there are other ways to save:

1. Use a SingleCare prescription discount card, which offers access to coupons to use at pharmacies across the country. With these free coupons, generic lurasidone might cost as little as $20 for 30, 20 mg tablets. You can use SingleCare coupons even if you’re on Medicare, but you can’t use them simultaneously with Medicare drug coverage. You’ll have to compare prices and see which gives you the bigger discount.

2. Consider a generic alternative. The FDA requires generic drugs to be “the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality.” Latuda isn’t the only atypical antipsychotic with a generic version, either. Aripiprazole is generic Abilify, asenapine is generic Saphris, and clozapine is generic Clozaril. Those are just a few of the many alternatives. Of course, it’s crucial to get medical advice from your healthcare provider before switching drugs.

RELATED: Latuda generic availability, cost, and dosage

3. Apply for Medicare Extra Help. This program helps Part D beneficiaries with limited incomes pay premiums, deductibles, coinsurance, and other costs. If you have Medicaid, you’ll be enrolled in Extra Help automatically.

4. Ask for a 90-day supply. Not only does buying in bulk reduce your trips to the pharmacy, but it can also save money and help you stick to your medication regimen, according to certain studies. Plus, fewer pharmacy visits means fewer copays. Ask your healthcare provider whether a three-month supply might work well for you. Choosing both a 90-day supply and generic lurasidone may result in significant savings.