Broad access and resources to support your patients

CAPLYTA has broad formulary coverage

For patients with Commercial Insurance:
  • Unrestricted access on the two largest PBMs — CVS Caremark & Express Scripts National Formulary
  • CAPLYTA is covered for >80% of patients
  • See the CAPLYTA Savings Card for additional support
For patients with Medicare Part D/Medicaid:
  • CAPLYTA is covered for >98% of patients

Source: Data on file, Intra‑Cellular Therapies, Inc. Formulary data provided by Managed Markets Insight and Technology, LLC™, a trademark of MMIT, as of 2022. Because formularies do change and many health plans offer more than one formulary, please check directly with the health plan to confirm coverage for individual patients.

Find help with a Prior Authorization

CAPLYTA offers a range of resources to assist you with Prior Authorizations.

Download the Pharmacy Callback Guide for step-by-step information on working with pharmacies

Visit CoverMyMeds to initiate the Prior Authorization process for both commercially and government‑insured patients.

CoverMyMeds services include:

  • Support for submitting requests to any health plan
  • Faster determinations, often in real time and with live monitoring
  • Appeal forms generated for denied requests

Generally, 8 out of 10 Prior Authorization submissions for CAPLYTA are approved

Learn about the CAPLYTA Savings Card

See how Medicare Part D/low‑income subsidy patients can receive help with prescription costs through Medicare1,2†

Medicare Part D patients are automatically enrolled in Extra Help if they are:
  • Dual eligible: receive both Medicare and Medicaid, or are older than 65 years and on Medicaid
  • Receiving Supplemental Security Income
  • Members of a Medicare Savings Program

Patients who are enrolled in Extra Help pay a maximum of $9.85 for brand name prescriptions3

Medicare beneficiaries receiving LIS get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments. Also, individuals enrolled in the Extra Help program do not have a gap in prescription drug coverage, also known as the coverage gap, or the Medicare "donut hole"1

This government program is also known as Extra Help.

Download a brochure to learn more about the CAPLYTA Patient Support Program

References: 1. Data on File. 2021. 2. eHealth Medicare. Low‑income subsidy-Medicare Extra Help Program. Accessed May 6, 2022. https://www.ehealthmedicare.com/medicare-part-d-articles/low-income-subsidy-medicare-extra-help-program. 3. Centers for Medicare and Medicaid Services. Medicare Prescription Drug Benefit Manual: Chapter 13-Premium and cost‑sharing subsidies for low‑income individuals. Updated July 29, 2011. Accessed May 6, 2022. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/Chapter13.pdf.