Indication: LYBALVI® is used in adults to treat manic or mixed episodes that happen with bipolar 1 disorder, either alone for short-term (acute) or maintenance treatment or in combination with valproate or lithium.
Indications: LYBALVI® is used in adults to treat schizophrenia. LYBALVI is also used in adults to treat manic or mixed episodes that happen with bipolar 1 disorder, either alone for short-term (acute) or maintenance treatment or in combination with valproate or lithium.
LYBALVI (olanzapine and samidorphan) Co-pay Savings Program
You may be able to save
For commercially insured eligible patients
$0 for the first 3 fills of LYBALVI
Am I eligible to save on LYBALVI?
If you have commercial insurance and are eligible for the LYBALVI Co-pay Savings Program, you can get the co-pay savings card, which makes you eligible to pay $0 for your first 3 fills of LYBALVI.
- After 3 fills, each refill may cost as little as $20, with maximum savings of $450 per 30-day supply
- Maximum lifetime savings limit applies; patients’ out-of-pocket expenses may vary
- Health plan requirements for a prior authorization and/or step therapies must be attempted, and outcome documented, regardless of outcome, prior to using this co-pay offer
- Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs
- Please see full Program Terms and Conditions
For illustrative purposes only.
For commercially insured eligible patients
There are 2 ways to get your Co-pay Savings Card: by text or with 1 click
On your phone
Text “COPAY” to 45286 to receive your Co-pay Savings Card.
By texting COPAY to 45286, you will receive texts with the LYBALVI Co-pay Savings Program Eligibility Requirements and Terms and Conditions. If you are eligible and agree to the Terms and Conditions, you will receive your co-pay savings card by text. Message/data rates may apply. Message frequency varies. You may opt out of receiving texts at any time by texting “STOP.”
- or -
On your computer
Download your Co-pay Savings Card below.
Click the button below and you will get a PDF that you can print or save to a device.
LYBALVI Co-pay Savings Program Terms and Conditions
Eligibility for LYBALVI® Co-pay Savings Program (Program): This Program is only available to commercially insured patients who are 18 years or older with a valid LYBALVI prescription. Health plan requirements for a prior authorization and/or step therapies must be attempted, and an outcome documented, regardless of the outcome, prior to using this co-pay offer. This Program is not available to patients who are enrolled in, or covered by, any local, state, federal or other government program that pays for any portion of medication costs, including but not limited to Medicare, including Medicare Part D or Medicare Advantage plans; Medicaid, including Medicaid Managed Care and Alternative Benefit Plans under the Affordable Care Act; Medigap; VA; DOD; TRICARE; or a residential correctional program. Patients who become eligible for any government program that pays for any portion of medication costs will no longer be eligible for this Program. Program is not valid for cash paying patients. Patients must live in the United States or Puerto Rico. Patients must meet the Program requirements every time they use the LYBALVI Co-pay Savings Card.
Program Benefit: Maximum savings limit applies; patients’ out-of-pocket expenses may vary. Maximum 30-day supply per fill for the first 3 fills in the Program. Beginning at fill 4 and thereafter, a maximum savings of $450 per 30-day supply will be provided towards the cost of the LYBALVI prescription. Eligible patients may receive benefits for valid claims submitted with a date of service that is up to 90 days prior to the initial enrollment date. All Program payments are for the benefit of the patient only. The LYBALVI Co-pay Savings Card expires after 5 years but may be renewed if all eligibility criteria are met.
Additional Terms of Use: This Program offer is not conditioned on any past, present, or future purchase, including refills. To use this Program, participating patients are responsible for following any health plan requirements, including any requirements to inform the health plan how much co-payment support they get from this Program. Program may be subject to plan benefit design requirements. Alkermes may rescind, revoke, or amend this Program, eligibility, benefits, and requirements at any time without notice, including in specific states. This Program offer is limited to one per patient and may not be used with any other coupon, discount, prescription savings card, free trial, or other offer and is not transferable; and may not be sold, purchased, or traded, or offered for sale, purchase, or trade. Void where prohibited by law, taxed or otherwise restricted. The Program is not insurance. Program Administrator or its designee will have the right upon reasonable prior written notice, during normal business hours, and subject to applicable law, to audit compliance with this Program.
Use and Disclosure of Information: By using this offer, you authorize the Program Administrator 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 LYBALVI prescription by your health insurance plan. Program Administrator will not share the patient’s personal information with anyone except where legally permitted. Data shared with Alkermes by the Program Administrator will be aggregated and de-identified and may be used by Alkermes for its own internal business purposes and/or to improve or modify the Program. For more information, see Alkermes’ Privacy Policy at www.alkermes.com/privacy.
To the Patient: Present this card and prescription for LYBALVI to the pharmacist to participate in this program. When using this card, you certify that you understand and agree to all of the Program Terms and Conditions and that you meet, or are the legal guardian of a patient who meets, the Program requirements. For questions about your eligibility or benefits, if your insurance has changed, or if you wish to discontinue your participation, call the LYBALVI Co-pay Savings Program at 1-855-820-9624 (8:00 AM-8:00 PM ET, Monday-Friday).
To the Pharmacist: When using this card, you certify that you will comply with the above Terms and Conditions and that you have not submitted and will not submit a claim for reimbursement under any local, state, federal, or other government program for this prescription. Submit transaction to McKesson Corporation (“Program Administrator”) using BIN 610524. Submit commercial insurance as primary coverage, input co-pay savings card information as secondary coverage, and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response. Acceptance of this card and your submission of claims for LYBALVI are subject to the LoyaltyScript® Program terms and conditions posted at www.mckesson.com/mprstnc. Claims submitted utilizing the Program are subject to audit or validation. For questions regarding setup, claim transmission, patient eligibility, or other issues, call the LoyaltyScript® Program for the LYBALVI Co-pay Savings Program at 1-855-820-9624 (8:00 AM-8:00 PM ET, Monday-Friday).
LYBALVI Pricing Information
The list price, also known as the Wholesale Acquisition Cost (WAC),* of LYBALVI is $1,599.20 for a 30-day supply, but most patients pay less with their prescription drug plan.
*The WAC is the published list price to wholesalers and distributors. The WAC does not necessarily represent actual transaction costs and does not include discounts, rebates, deductions or applicable taxes, if any. The stated price reflects the WAC as of July 2024.
For more LYBALVI Co-pay Savings Program information, call 1-855-820-9624
Speak with a representative, Monday through Friday, 8 AM to 8 PM ET.What's next?
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