Rexulti costs vary widely depending on your Medicare plan and pharmacy

The out-of-pocket cost for Rexulti (brexpiprazole) under Medicare ranges from around $10 to $500+ per month, depending on which Medicare plan you have, which pharmacy you use, and which dosage your doctor prescribes. There is no single Medicare price — what you pay depends on whether you have Original Medicare with a Part D plan, a Medicare Advantage plan with drug coverage, or no drug coverage at all.

The best way to find your actual cost is to check your specific plan's formulary (the list of covered drugs) and call your pharmacy, because prices change and vary by location. Your plan's website usually has a tool where you can search for Rexulti and see what tier it sits on and what your copay would be.

Key Takeaways

  • Rexulti is a brand-name antipsychotic medication, and Medicare Part D plans cover it but place it on different tiers, which changes your out-of-pocket cost.
  • Your actual cost depends on your specific plan, your pharmacy, and which dosage strength your doctor prescribes — calling your pharmacy is faster than guessing.
  • If your copay is too high, you can ask your doctor about generic alternatives or request a coverage exception from your plan, though approval is not may provide.
  • Some pharmaceutical information programs run by the manufacturer offer cost help to people with Medicare, but income limits explore.

How Medicare Part D plans cover Rexulti

Medicare Part D (prescription drug coverage) covers Rexulti, but each plan decides which tier to place it on. Tier 1 drugs (generics) have the lowest copay. Tier 2 (preferred brand-name) and Tier 3 (non-preferred brand-name) have higher copays. Rexulti usually lands on Tier 3 or Tier 4 because it is a newer brand-name drug without a generic version yet.

Your copay for a Tier 3 or Tier 4 drug is typically a percentage of the drug's cost (called coinsurance) rather than a flat dollar amount. This means if the pharmacy's price for Rexulti is $400, you might pay 25% to 33% of that, which comes to $100 to $130. Once you reach your plan's deductible and out-of-pocket maximum, your costs change again.

The exact tier and copay are in your plan's formulary. You can find this on your plan's website or by calling the customer service number on your Medicare card.

Medicare Advantage plans and Rexulti coverage

Medicare Advantage (Part C) plans that include drug coverage (usually called MA-PD plans) also cover Rexulti, but the copay structure and amount differ from plan to plan. Some MA-PD plans have lower copays for Rexulti than Original Medicare Part D plans do, and some have higher ones.

The only way to know what you will pay is to check your specific plan's formulary or call your plan's pharmacy line. If you are considering switching plans during open enrollment, comparing Rexulti's cost across plans you are interested in can help you choose the one that fits your budget.

What happens if you have no drug coverage

If you have Original Medicare but no Part D plan, or if you have a Medicare Advantage plan without drug coverage, you pay the full pharmacy price for Rexulti out of pocket. The cash price at a typical pharmacy ranges from $300 to $600 per month depending on the dose and the pharmacy, though prices vary by location and retailer.

In this situation, you have several options: you can enroll in a Part D plan during the annual open enrollment period (October 15 to December 7), you can look into manufacturer information programs, or you can ask your doctor whether a generic antipsychotic might work for you.

Generic alternatives and cost savings

Rexulti does not have a generic version yet. However, other antipsychotic medications do have generics, and they are significantly cheaper. Generic aripiprazole, quetiapine, and risperidone are all covered by Medicare Part D, usually on Tier 1 or Tier 2, with copays of $5 to $15 per month.

If your doctor prescribed Rexulti but the cost is a barrier, ask whether one of these generic alternatives might work for your condition. Your doctor knows your medical history and can tell you whether a switch is safe. Some people do better on one antipsychotic than another, so this is a conversation to have with your prescriber, not a decision to make on your own.

Manufacturer information and other cost programs

Otsuka Pharmaceutical, which makes Rexulti, runs a patient information program called the Rexulti Support Program. This program can reduce or eliminate your copay if your income is below certain limits. The income thresholds vary, but generally the program is open to people with household income up to 200% to 300% of the federal poverty level.

To learn whether you may be able to use this program, visit the Rexulti Support Program website or call 1-844-REXULTI (1-844-739-8584). You will need to provide proof of income and your Medicare information. The program can take two to four weeks to process.

You can also ask your pharmacy about discount programs like GoodRx or SingleCare, which sometimes offer prices lower than your Medicare copay. These are not insurance — they are discount cards that you present at the pharmacy instead of your insurance card. Compare the discount price to your copay before you decide which to use.

Requesting a coverage exception from your plan

If your doctor believes Rexulti is medically necessary and you cannot afford the copay, you can ask your Medicare plan for a coverage exception. This is a formal request to your plan asking them to move Rexulti to a lower tier or to cover it in a way that lowers your cost.

Your doctor will need to submit a letter explaining why Rexulti is the right medication for you and why other options would not work. The plan has 72 hours to respond in urgent cases and up to 14 days in standard cases. Approval is not may provide, but it is worth asking if cost is the only barrier between you and the medication your doctor recommends.

Frequently Asked Questions

Does Medicare cover Rexulti at all?

Yes, Medicare Part D plans cover Rexulti, but it is usually on a higher tier (Tier 3 or 4), which means your copay is higher than it would be for a generic drug. Medicare Advantage plans with drug coverage also cover it. If you have no drug coverage, you pay the full pharmacy price.

Can I switch to a cheaper Medicare plan mid-year to lower my Rexulti cost?

No, you cannot switch Part D plans outside of the annual open enrollment period (October 15 to December 7) unless you have a may have access to life event like moving to a new state or losing other coverage. If your current plan's copay is too high, you can wait until open enrollment and compare plans then.

What if my doctor says I need Rexulti and not a generic?

Ask your plan for a coverage exception and have your doctor explain in writing why Rexulti is medically necessary. You can also ask about the manufacturer's patient information program or discount cards. If cost remains a barrier, discuss this with your doctor — they may have other options or know of resources you have not tried yet.

Will my Rexulti copay change if I reach my out-of-pocket maximum?

Yes. Once you reach your plan's out-of-pocket maximum for the year, Medicare and your plan cover the full cost of Rexulti, and you pay nothing. The out-of-pocket maximum varies by plan but is capped by Medicare at a certain amount each year. Check your plan documents to see what that maximum is.

Is there a way to pay less than my copay?

Sometimes. Discount programs like GoodRx or SingleCare may offer a lower price than your Medicare copay, and the manufacturer information program can reduce or eliminate your copay if you meet income limits. Always compare the discount price to your copay before using a discount card instead of your insurance.