Does Medicaid cover Rexulti?

In this article:

• Is Rexulti covered by Medicaid?
• How much does Rexulti Cost?
• Cost of Rexulti with Medicaid
• Ways to get discounts on Rexulti without Medicaid

In this article

• Is Rexulti covered by Medicaid?
• How much does Rexulti Cost?
• Cost of Rexulti with Medicaid
• Ways to get discounts on Rexulti without Medicaid

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’s disease. Rexulti acts on dopamine and serotonin, chemicals in the brain, to correct imbalances and ease the symptoms of schizophrenia and MDD.

Although Rexulti is effective, it is an expensive drug to make. For those relying on Medicaid, coverage for Rexulti can vary.  

Is Rexulti covered by Medicaid? 

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:

• Prior authorization: In some states, Medicaid may require 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.
• Step therapy: Medicaid may require you to try other less expensive or more established medications before approving Rexulti.  

To determine if your state’s state’s program covers Rexulti, check your state’s state’s website or contact your local Medicaid office. Your healthcare provider or pharmacist can also help.

How much does Rexulti Cost? 

Rexulti costs $1,965 for 30, 1 mg tablets without insurance. Prices fluctuate, however, and they also vary by dosage and pharmacy. 

Cost of Rexulti with Medicaid 

The cost of Rexulti with Medicaid is about $2.88 per month on average, according to the manufacturer of Rexulti, Otsuka America Pharmaceutical Inc. You may pay more or less depending on your state of residence.

Each state Medicaid program has its own preferred drug list (PDL), 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’t 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.

Ways to get discounts on Rexulti without Medicaid 

If you don’t have Medicaid or if your state doesn’t cover Rexulti, there are other ways to save. For example, the SingleCare prescription discount card can help you save on Rexulti at thousands of participating pharmacies across the country. With a Rexulti coupon, you could pay $1,374 instead of $1,965 for a one-month supply. Although anyone can use SingleCare coupons, you can’t combine savings with Medicaid benefits. 

You can also talk to your healthcare provider about Rexulti alternatives. Although there’s no lower-cost generic version of Rexulti yet, some Rexulti alternatives may have generic versions that are more affordable. 

Keep in mind that beneficiaries who have both Medicaid and Medicare are considered dually eligible, so you may be able to apply for Medicare Extra Help 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.

RELATED: How much does Rexulti cost with Medicare?