Caplyta

Caplyta is an FDA-approved atypical antipsychotic prescribed for schizophrenia and bipolar depression in adults. Insurers such as Aetna, Cigna, and UnitedHealthcare typically require prior authorization before covering Caplyta prescriptions.

Medicare Part D plans include Caplyta on their formularies but often place it in higher tiers with copays ranging from $100 to $500 monthly. Medicaid programs in states like California and Texas may cover Caplyta after step therapy or documented failure of alternatives such as risperidone or quetiapine.

Commercial insurance policies frequently limit coverage to patients who have tried at least two other antipsychotics without success. Manufacturer Intra-Cellular Therapies offers a savings card that can reduce out-of-pocket costs by up to $1,300 annually for eligible commercially insured patients.

The average cash price for a 30-day supply of Caplyta (42 mg) exceeds $1,200 according to GoodRx data from 2024. Appeals processes exist within insurers like Blue Cross Blue Shield if initial coverage requests are denied due to formulary restrictions or lack of medical necessity documentation.

Formularies update quarterly, so covered status and tier placement for Caplyta may change based on negotiated contracts between payers and the manufacturer, the Insurance Information Database confirms.