Brexpiprazole (Rexulti)

• Partially covered under Medicare part D for AD WITH agitation
• Generic form not yet available at pharmacies
• UTD cost lists brexpiprazole as $60 vs sertraline (zoloft) is $6
• Starting in 2025, Medicare no longer has a ‘donut hole,’ or coverage gap
• Once you reach the annual out-of-pocket cap ($2,000 in 2025), you’re done paying out of pocket for the year Medicare Donut Hole: What Was It? - NerdWallet
• Medicare Stages 2025
• Deductible stage: If your Medicare plan has a deductible, you pay all out-of-pocket costs until you reach the full deductible. No Medicare drug plan may have a deductible more than $590 in 2025. Some Medicare drug plans don’t have a deductible.
• Initial coverage stage: After you reach your full deductible (if your plan has a deductible), you’ll pay 25% of the cost as coinsurance for your generic and brand-name drugs until your out-of-pocket spending on covered Part D drugs reaches $2,000 in 2025 (including certain payments made on your behalf, like through the Extra Help program). Then, you’ll automatically get “catastrophic coverage.”
• Catastrophic coverage stage: You won’t have to pay out-of-pocket for covered Part D drugs for the rest of the calendar year. How much does Medicare drug coverage cost?
• REXULTI is a Tier 5 “Specialty Tier” Medication
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• List price of REXULTI = $1515.69 / month
  • Rexulti manufacturer claims with Medicare, out-of-pocket costs for REXULTI prescriptions average about $21.37 per month.† Of course, out-of-pocket costs vary throughout the year, depending on which phase of Part D you’re in and if you're enrolled in a Medicare Prescription Payment Plan (MPPP). REXULTI® (brexpiprazole) | Savings & Cost Information
• Actual out of pocket monthly costs likely to be higher than manufacturers estimate (see below)
• Sample monthly cost if you ONLY have medicare part D and receive no other assistance or are NOT enrolled in a payment plan
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