Does Medicaid cover Vraylar?

In this article:

• How much does Vraylar cost?
• Does Medicaid cover Vraylar?
• Factors influencing Medicaid coverage for Vraylar
• How to get Vraylar with Medicaid
• Costs of Vraylar with Medicaid
• How to save on Vraylar

In this article

• How much does Vraylar cost?
• Does Medicaid cover Vraylar?
• Factors influencing Medicaid coverage for Vraylar
• How to get Vraylar with Medicaid
• Costs of Vraylar with Medicaid
• How to save on Vraylar

Vraylar (cariprazine) is a prescription drug that treats mental health conditions like schizophrenia and the manic or mixed episodes associated with bipolar I disorder. Vraylar is also approved to treat bipolar depression associated with bipolar I disorder, and can also be used along with antidepressants to treat depression. It’s an atypical antipsychotic (second generation), which means it’s less likely than its first-generation counterparts to cause serious side effects. But that combination of effectiveness, versatility, and reassurance often comes at a cost.

Vraylar’s exact price can vary based on insurance coverage and the reason for taking it. But the good news is that it’s often covered by Medicare and Medicaid plans. Even so, coverage depends on your specific condition and circumstances.

How much does Vraylar cost?

Without assistance from insurance, Medicare, Medicaid, or other discounts, Vraylar costs an average of $1,994 for 30, 1.5 mg capsules—a one-month supply—which breaks down to around $66 per dose.

Fortunately, not everyone is stuck paying that price. “The price of Vraylar depends on the patient’s prescription, insurance, and the pharmacy from which they purchase the drug,” says Matt Grammer, a licensed professional clinical counselor and founder of Counseling Now. Some private health insurance plans may cover part of that price, and Medicare Part D plans may provide coverage as well. Each plan has its own policies and formulary, so check with your insurance provider for specific coverage details. Even without coverage, the cost can vary based on where you get your medication, as prescription drug prices can vary significantly between pharmacies.

There’s no generic version of Vraylar yet, which might contribute to the drug’s cost as well. Once generic options hit the market, the price of their brand-name equivalents typically drop.

Does Medicaid cover Vraylar?

“Though coverage is never guaranteed with atypical antipsychotics like Vraylar, many Medicaid insurance plans do cover it,” says Abid Nazeer, MD, psychiatrist and chief resident at Symetria Recovery. But since it’s funded in part by individual state governments, each state might have slightly different out-of-pocket costs.

You can find basic information about each state’s requirements and procedures on your state’s Medicaid website. But to check your state’s specific drug coverage, visit the state government’s Medicaid program website. These pages typically house each state’s formulary—a list of covered drugs—and other information. One simple way to find a state’s formulary is by searching “[State] Medicaid Formulary.” It should show up as one of the first few links. Then, just find Vraylar to see how it’s covered. You can also call your state’s health department or Medicaid office with questions.

Factors influencing Medicaid coverage for Vraylar

Although most Medicaid plans cover Vraylar, the extent to which they cover your out-of-pocket costs may vary since they all have different cost-sharing policies. For example, some states might require patients to pay for copays, while others might cover them. Each state also has the right to impose coinsurance, deductibles, and similar charges, which may influence your final Vraylar price.

Medicaid plans classify drugs as either “preferred” or “nonpreferred.” If a drug is preferred, may have lower copays or no prior authorization requirements than nonpreferred drugs. Whether Vraylar is preferred or not depends on the state plan, but these lists are constantly changing. 

Medicare formularies, however, may organize medications into a tier system that determines the extent of their coverage. Lower-tier drugs, like generics, often receive better coverage than higher-tier ones, like brand-name and specialty medications. According to Grammer, many Medicare plans place Vraylar in a higher tier. This “may result in a patient paying a higher copay or coinsurance for the medication,” he says. “Patients who want to purchase Vraylar with Medicaid should review the plan’s formulary and discuss the options with the doctor or pharmacist to obtain the best coverage.”

Antipsychotics are consistently part of Medicaid’s drug utilization reviews (DUR), which assess drug abuse and misuse. This can also influence coverage policies, so be sure to check the most recent one.

How to get Vraylar with Medicaid

Even when a state’s Medicaid covers Vraylar, it might not be as simple as simply going to the pharmacy and presenting your information.

“Some insurance plans have stricter coverage parameters, which may include prior authorization before Vraylar is considered a possible option,” Dr. Nazeer says. “In most cases, a patient needs to have a verifiable diagnosis of bipolar disorder, schizophrenia, or major depressive disorder. Vraylar is not controlled, but an insurance carrier will likely not cover it if the patient doesn’t appear to need it. Licensed therapists and psychiatrists can provide a formal diagnosis, and then an insurance carrier will likely approve it.”

Other plans might request that you go through step therapy. During this process, the patient tries other (often less expensive) medications and only receives Vraylar coverage if those alternatives don’t work. Either way, Vraylar always requires a prescription from your healthcare provider. They’ll send it to your preferred pharmacy, and you can pick it up when it’s ready.

Costs of Vraylar with Medicaid

As we’ve mentioned, Vraylar prices depend on a few factors, even with Medicaid coverage. Vraylar’s manufacturer, AbbVie, says most Medicaid beneficiaries will pay $4 or less for their prescription. That’s because most states’ Medicaid prescription drug copays are lower than $4, even for nonpreferred drugs. Some states will even cover it 100%, including copays, so you might even walk away without paying anything.

How to save on Vraylar

Even if your Medicaid plan covers Vraylar, costs can add up. There are a few ways to save on Vraylar, although you may not be able to combine them with Medicaid benefits. For example, signing up for a SingleCare savings card can provide you access to Vraylar coupons at pharmacies across the country. At the time of publication, you could pay $1,298 instead of $1,994 for 30, 1.5 mg capsules. The savings card is free, but you can’t combine SingleCare discounts with Medicaid benefits. 

You could also talk to your healthcare provider about a Vraylar alternative. There are other medications for schizophrenia and bipolar depression out there, and several other second-generation antipsychotics—like Clozaril, Seroquel, and Abilify—have generic options that may come at much lower prices. For example, clozapine (generic Clozaril) could cost as little as $19 with a SingleCare coupon. First-generation antipsychotics might also be cheaper, but doctors don’t prescribe them as much because their side effects can be more severe. No matter which alternative medication you’re considering, consult a healthcare provider to know which might work best for you.

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