Does Medicare Cover Rexulti?
- Rexulti is a costly drug used to treat schizophrenia. If your doctor recommends Rexulti, knowing whether Medicare covers your medication can be helpful.
Finding the right treatment for schizophrenia is essential for managing your symptoms, but it can also be stressful if your doctor prescribes an expensive drug. Fortunately, your prescription drug insurance can often help if you need to take costly drugs long-term. Below, we'll explore Medicare coverage for Rexulti — one of the more costly medications used to control the symptoms of schizophrenia.
What Is Rexulti?
Rexulti is the brand name of the generic medication brexpiprazole, an antipsychotic medication used to treat schizophrenia. Sometimes, doctors prescribe Rexulti for people with depression if more conventional treatments haven't provided adequate symptom relief. The medication works by promoting healthy levels of chemicals in the brain that affect your mood.
Doctors usually prescribe a starting dose of 1 milligram to treat schizophrenia or 0.5 to 1 milligram to treat depression. If you have depression, you'll usually take other medications alongside Rexulti. Your health care provider may gradually increase the amount you take, up to a maximum of 4 milligrams daily, until your symptoms improve.
Taking Rexulti is less likely to lead to significant weight gain than many comparable medications. However, it can cause side effects, which may include:
- Acid reflux
- Diarrhea or constipation
Does Medicare Cover Rexulti?
As there's no generic version, all Medicare Part D plans cover Rexulti specifically. You'll also likely have Rexulti coverage if you're a Medicare Advantage enrollee and your policy includes prescription drug coverage.
However, you won't have coverage if you're only enrolled in Medicare Parts A and B (Original Medicare.) Parts A and B only cover a small range of medications administered by a health care provider in a clinic or hospital, such as certain injections.
How Much Does Rexulti Cost With Medicare?
The average retail price for 30 1-milligram tablets of Rexulti is $1,581.51, making it an expensive medication. However, you'll only pay for your Rexulti prescription out of pocket until you meet your yearly deductible if you have prescription drug coverage.
In practice, this means that Medicare Part D enrollees become eligible for coverage with their first prescription because the maximum Part D deductible ($480 in 2022 and $505 in $2023) is substantially lower than the cost of Rexulti. Therefore, you pay your deductible, and your insurer covers the rest of the cost, minus a co-pay. Copays for Rexulti usually range between $12 and $48.
Your deductible could be substantially higher or lower if you're a Medicare Advantage beneficiary because insurance companies can set their own deductibles for these plans. Check your policy paperwork to learn about cost-sharing arrangements for your Medicare Advantage plan.
Rexulti Coverage Restrictions With Medicare
Medicare Part D and Medicare Advantage insurers typically require prior authorization before agreeing to pay for Rexulti. Therefore, your doctor must usually get in touch with your insurer to verify the reason for prescribing your medication and that it's medically necessary. Also expect quantity restrictions limiting how much medication your pharmacy can give you per visit.