How much does Rexulti cost with Medicare?

In this article:

• How Medicare covers prescription drugs
• Does Medicare cover Rexulti?
• What is the cost of Rexulti on Medicare?
• How the prescription drug law affects Rexulti
• How to save on Rexulti

In this article

• How Medicare covers prescription drugs
• Does Medicare cover Rexulti?
• What is the cost of Rexulti on Medicare?
• How the prescription drug law affects Rexulti
• How to save on Rexulti

Rexulti (brexpiprazole)is a prescription drug that was approved in 2015 by the Food and Drug Administration (FDA). In addition to schizophrenia, it is prescribed to treat major depressive disorder when combined with other medications. In 2023, Rexulti was approved for treatment of agitation associated with dementia from Alzheimer’s disease. Rexulti is not meant to be used as an “as needed” medication for this condition, however.

“Rexulti is kind of an add-on drug for residual symptoms in people with major depressive disorder who are already on other medications,” explains Jenepher K. Piper, a certified registered nurse practitioner at Mercy Medical Center in Baltimore, Maryland. “Instead of upping the dose of what the person is currently taking, Rexulti could be added and the dose of the first medication kept at the same level. Having lower doses of two drugs rather than a higher dose of one drug gives better results.”

Without insurance, Rexulti costs over $1,900 per month. But with Medicare, the average Part D beneficiary pays about $21 per month. Here’s everything you need to know about how much you can expect to pay for Rexulti with Medicare.

How Medicare covers prescription drugs

When you have original Medicare, which includes Medicare Part A (for inpatient hospital care) and Medicare Part B (for healthcare provider services, outpatient care, and medical supplies), you have some choices when it comes to prescription drug coverage.

One option is to purchase a stand-alone Medicare Part D plan. Each insurance plan has a list of covered drugs known as a formulary, with drugs assigned certain levels, called “tiers.” Drugs in the lower tiers generally cost less than drugs in higher tiers. Formularies can change what tier they assign a particular drug at any time. If you already take certain drugs, you should compare the formularies of several plans so that you can choose the best plan for you.

Another option instead of enrolling in a stand-alone Part D plan is to enroll in a Medicare Advantage plan—a way of receiving your inpatient and outpatient Medicare benefits through private companies. These companies must follow rules set by Medicare. In addition to medical and prescription drug coverage, these plans may include preventive dental, vision, and hearing benefits. When you have a Medicare Advantage plan, your prescription drug plan is typically built in. 

Does Medicare cover Rexulti?

If you have Medicare drug coverage either through Medicare Advantage or Part D, the cost of your Rexulti prescription may be partially covered. But Medicare will not cover Rexulti if it is prescribed for Alzheimer’s disease and dementia without agitation. “Nor will Medicare cover Rexulti if it is the only medication being prescribed for major depressive disorder,” Piper says.

While your Medicare drug coverage may cover part of the cost of Rexulti, you will most likely be responsible for part of the cost. “There is such a big variation among the various insurance plans and what they charge,” says Selly Vazquez, an insurance specialist in Brookfield, Connecticut. When a drug costs thousands of dollars per month, she explains, it typically means that it is in Tier 4 or Tier 5 on the insurance company’s formulary. “The price really varies from plan to plan.”

What is the cost of Rexulti on Medicare?

The list price of Rexulti is $1,419 per month, though this is not the cost that most people will actually pay. In fact, the average retail price of Rexulti is over $1,900 for a 30-day supply. According to Otsuka America Pharmaceutical, Inc., which manufactures Rexulti, your out-of-pocket costs for Rexulti with Medicare could be around $21 per month. However, this varies by plan and what coverage stage you are in, among other factors.

During the first stage, you’ll pay the full cost of your prescriptions until you meet your deductible. In 2024, no deductible can be higher than $545. During the next stage, you and your Medicare drug plan share the cost of covered drugs according to the plan’s formulary. Once you and your plan have spent a specific amount on covered drugs ($5,030 for 2024), you’re in the coverage gap, also called the donut hole. Here, you typically pay 25% of the cost of your brand-name and generic drugs. Once your out-of-pocket costs (deductible, coinsurance, copays, and anything you paid during the coverage gap) reach $8,000, you can enter the final stage: the catastrophic stage, during which your plan pays the entire cost of covered drugs for the rest of the year. 

One issue with getting Rexulti paid for by Medicare is that a person’s insurance company may require step therapy and prior approval. “The company wants the patient to fail on other drugs that are cheaper before they will approve Rexulti,” Piper says.

How the prescription drug law affects Rexulti

Under the new prescription drug law that went into effect on Jan. 1, 2023, people with Medicare Part D drug coverage don’t have to pay copays or coinsurance if their drug costs are high enough to reach the catastrophic coverage phase. And in 2025, annual Part D out-of-pocket costs will be capped at $2,000. For the first time, Medicare will negotiate directly with the manufacturers over the price of certain brand-name drugs. 

How to save on Rexulti

There are a few ways to make Rexulti more affordable:

• Use your SingleCare prescription discount card. The card is free and provides access to Rexulti coupons to use at pharmacies across the country. In some cases, your cost with SingleCare may be lower than your copay with Medicare. At the time of publication, the average retail price of Rexulti was $1,941 for 30, 1mg tablets. But with a SingleCare coupon for Rexulti, you could pay $1,374. Although Medicare beneficiaries can use SingleCare coupons, they can’t use the coupons in combination with Medicare benefits. 
• Consider Rexulti alternatives. Your healthcare provider may prescribe a less expensive medicine if Rexulti is too costly. “For some forms of depression, there are other drugs such as Abilify, Seroquel, and Vraylar,” Piper says. 

Unfortunately, there is not yet a generic version of Rexulti. 

• Look into Medicare Extra Help. You could pay less for Rexulti if you are eligible for the Social Security Administration’s Extra Help program. Eligible beneficiaries could have copays of around $11.20 per fill of Rexulti.