Why is Caplyta so expensive?

Key takeaways

• Drugs like Caplyta may be so expensive because they’re branded medications without a generic version available. Newer branded drugs typically have market exclusivity for a number of years.
• The cost of Caplyta likely depends on whether you have insurance and whether you use savings programs or prescription discount cards.
• You can use the Optum Perks discount card, drug coupons, or manufacturer savings programs to save on your medication costs.

Overview

Caplyta is a brand-name medication used to manage mental health conditions like bipolar disorder and schizophrenia. Because it is a brand-name drug, this may mean it is more expensive than generic alternatives.

There are many costs associated with healthcare in the United States, and prescription medications are no exception. There are many reasons why your medications may be expensive or cost more than similar alternatives. However, there are also ways you may be able to save on your prescription costs.

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Why are prescriptions so expensive?

In the United States, costs associated with prescription medications are increasing. According to some 2022 research, drug costs between 2021 and 2022 increased faster than the rate of inflation for that time. There are many reasons why drugs like Caplyta may be so expensive.

First of all, Caplyta is a brand-name medication, and there is no generic alternative available. It’s a newer drug that received approval in December 2019.

Once the Food and Drug Administration (FDA) has approved a brand-name drug, it gives patent and exclusivity protection to the manufacturers for several years, meaning that no generic versions of the drug can compete with the branded version. This is because of the time the manufacturer has spent developing and testing the drug.

The length of the patent depends on the specific drug, but it may be as long as 20 years. However, the exclusivity period may end sooner than this time.

Drug manufacturers set the price of the branded medication, and when there are no other alternatives, the manufacturers have a monopoly on selling the drug. While there are some regulations associated with drug pricing in the U.S., there are fewer regulations than in other countries, so drugmakers have more freedom with pricing.

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How much does Caplyta cost?

According to the drug manufacturer, the list price of Caplyta is $57 per capsule and $1709.94 per bottle. However, how much you’ll actually pay for Caplyta depends on several factors, such as where you’re located, what pharmacy you visit, and whether you have insurance.

While the medication may be very expensive without insurance, according to Caplyta’s manufacturer, 93% of Americans have insurance coverage for Caplyta. This means your insurance may pay for all or part of your medication costs, depending on your plan.

Your insurance plan will come with something called a formulary, which is a list of all the drugs your plan will cover. Some drugs may be completely covered, while others, known as “higher-tier” medications, may require a moderate copayment. If you haven’t met your deductible yet for the year, you may also need to pay until you reach this limit.

The price of Caplyta will also depend on whether you have any coupons, discount cards, or savings programs.

How to save on prescription costs

If your drug costs are too expensive for you to manage, there are several ways you may be able to save on your prescription costs:

• Optum Perks: The Optum Perks Discount Card is a free card you can download or print and take to a pharmacy to get your prescription at the website-listed price. It may be able to save you up to 80% on prescription drug costs. This card can’t be used alongside insurance and doesn’t count toward deductibles. The Optum Perks website can also point you in the direction of manufacturer savings programs, if they exist.
• Use the manufacturer savings program: Caplyta’s manufacturer offers a savings card where you can pay $0 for your first two 30-day supplies of the drug, then $15 for the following fills, up to a 90-day supply. You must have commercial insurance to access this discount, and it isn’t eligible for use with Medicaid or Medicare plans.
• Prescription assistance programs: Depending on your household income, you may be able to access programs that can help pay for your prescription costs. You can find a list of available programs by state here.
• Discuss alternatives with a doctor: While there is no generic version of Caplyta available, there may be other antipsychotic drugs that have cheaper generics available. Some similar medications that are available in generic forms include aripiprazole (Abilify) and risperidone (Uzedy) A doctor may be able to work with you to find an appropriate drug for you that is also cheaper.

Summary

Caplyta is a brand-name medication that’s used to manage schizophrenia and bipolar disorder. Prescription drug costs in the U.S. can be very high, and Caplyta is no exception.

Caplyta is so expensive because it is a newer drug that is not available in a generic form. It will have a patent and exclusivity for several years before a generic is available.

However, there are many ways you can save money on your prescriptions. Optum Perks and manufacturer savings programs may help you to afford Caplyta.

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Download the free Optum Perks Discount Card to save up to 80% on many prescription medications. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.