Resources & Support

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Coverage & support

CAPLYTA has broad formulary coverage

Commercial Insurance only:

Unrestricted access on the two largest PBMs – CVS Caremark & Express Scripts National Formulary
Covered for ~90% of Commercial Patients
Eligible* patients may pay as little as $0 for their first two fills, up to a 30-day supply, and $15 for subsequent fills up to a 90-day supply with their CAPLYTA Savings Card. Please see eligibility Criteria and Terms & Conditions.

Medicare Part D/Medicaid:

Covered for >98% of Patients

Source: Data on File.

Medicare Part D/low-income subsidy patients^9,10

See how the Medicare Extra Help Program can assist Medicare Part D/low-income subsidy patients with prescription costs.

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 $11.20 for brand name prescriptions.¹¹
- 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”⁹

277 million Americans (or 93% of American lives) have access to CAPLYTA across all payer channels

Prior Authorization support

You can visit www.CoverMyMeds.com to initiate the Prior Authorization process for both commercially and government-insured patients. Generally, ~8 out of 10 Prior Authorization submissions for CAPLYTA are approved.

1-866-452-5017

Live chat at

Mon - Fri 8:00am - 11:00pm ET

Sat 8:00am - 6:00pm ET

Pharmacy call back guide

Download a guide to help you and your office staff handle pharmacy rejections so your patients can access CAPLYTA.

CAPLYTA® (lumateperone) prior authorization submission guide

Prior Authorization submission information

Download a helpful guide to use when filling out and submitting Prior Authorizations for CAPLYTA for your patients.

*This offer is valid for eligible new or existing patients who are filling a prescription for CAPLYTA. Eligible patients must be 18 years of age or older, residents of the U.S., excluding Puerto Rico and have a valid prescription for CAPLYTA for a Food & Drug Administration approved indication. This Savings program is valid ONLY for patients with private commercial insurance and NOT valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs. Offer is only good at participating retail pharmacies. Offer is not transferable, is not insurance, has no cash value, and may not be used in combination with other offers. Void if prohibited by law, taxed, or restricted.

All participants are responsible for reporting the receipt of all Program benefits as required by their insurance provider. No party may seek reimbursement for all or any of the benefit received through this Program. Intra-Cellular Therapies, Inc. reserves the right to rescind, revoke or amend the Program without notice at any time. Additional eligibility criteria apply. Click here for full Eligibility Criteria and Terms and Conditions.

By using the CAPLYTA savings card, you acknowledge that you currently meet all Eligibility Criteria and Terms and Conditions and will comply with the terms and conditions below.

PROGRAM ELIGIBILITY CRITERIA AND TERMS & CONDITIONS:

This offer is valid for eligible new or existing patients who are filling a prescription for CAPLYTA.

Patients must be 18 years of age or older, residents of the United States, excluding Puerto Rico, and have a valid prescription for CAPLYTA.

Patients must have private commercial insurance. Offer is not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs (such as medical assistance programs). This offer is not insurance, has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, savings, or similar offer.

This savings card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs. You must deduct the value of this savings card from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf. You are responsible for reporting use of the savings card to any private commercial insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the savings card, as may be required. You should not use the savings card if your insurer or health plan prohibits use of manufacturer savings cards.

This offer is good only at participating retail pharmacies. This card may not be redeemed for cash. Void if prohibited by law, taxed, or restricted. Eligible patients may pay as little as $0 on the first two fills, up to the maximum lifetime benefit based on current list price of 30-day supply. On subsequent uses, eligible patients may pay as little as $15, up to the maximum benefit of $600. Program benefit calculated on FDA-approved dosing.

A valid Prescriber ID# is required on the prescription.

Data related to the redemption of this savings card may be collected, analyzed, and shared with Intra-Cellular Therapies, Inc. for market research and/or other purposes related to assessing the CAPLYTA Savings Program.

By using this offer, you authorize the CAPLYTA Savings Program to share your prescription information with CoverMyMeds so that CoverMyMeds may contact your healthcare provider to request submission of information to support coverage of your CAPLYTA prescription by your health insurance plan.

This program is valid through 04/30/2024.

No other purchase is necessary.

Intra-Cellular Therapies reserves the right to rescind, revoke, or amend this offer without notice.

Patients with questions about the CAPLYTA Savings Card should call 1-800-639-4047.

Pharmacist: When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the terms and conditions described in the Restrictions section below.

Pharmacist instructions for a patient with an Eligible Third Party: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer as a copay-only billing using a valid Other Coverage Code. Eligible patients may pay as little as $0 on the first two uses, up to the maximum lifetime benefit based on current list price of 30-day supply. On subsequent uses, eligible patients may pay as little as $15, up to the maximum benefit of $600. Reimbursement will be received from Change Healthcare.

For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-433-4893.

Restrictions: This offer is valid in the United States, excluding Puerto Rico. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs (such as medical assistance programs). Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. Program expires 04/30/2024. This offer is not transferable and is limited to one offer per person. Not valid if reproduced.

Void where prohibited by law. Program managed by ConnectiveRx on behalf of Intra-Cellular Therapies.

Intra-Cellular Therapies reserves the right to rescind, revoke, or amend this offer without notice at any time.

Cost & savings

**Eligible* patients may pay as little as $0 for their first two fills up to a 30-day supply,** and $15 for subsequent fills of CAPLYTA up to a 90-day supply.

Download or text to access the Savings Card:

Download the card and provide it to your eligible* patients.

Are you a licensed prescriber in the state of Vermont?

Yes

Savings Card

Eligible* patients can text "CAPLYTA" to 26789 to receive the Savings eCard on their phones through the CAPLYTA text message program.Download a digital Savings Card to your phone and receive useful text messages about your prescription.Get text messages right to your phone. Get alerts on how much you're saving, refill reminders, and the status of your insurance coverage. Plus, you'll have the option to order refills via text. Patients can opt out of this program at any time.

Message & Data Rates may apply. Message frequency varies. Terms & Conditions apply: www.engagedrx.com/CAP. Once enrolled, text HELP for help. Text STOP to end.