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 below for full Program Terms and Conditions
LYBALVI® (olanzapine and samidorphan) Co-pay Savings Program card

For illustrative purposes only.

For commercially insured eligible patients

Get your Co-pay Savings Card with 1 click

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.

  • I am 18 years or older and have a valid prescription for LYBALVI.
  • I have commercial insurance and am not 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 or Medicaid, Medigap, VA, DOD, TRICARE or a residential correctional program).
  • I understand and agree to comply with all of the Terms and Conditions of the LYBALVI Co-pay Savings Program.

Please read the LYBALVI Co-pay Savings Program Terms and Conditions and our Privacy Policy. Alkermes will not sell, share, use or distribute your personal information outside the terms of these agreements.

Sorry, there was a problem downloading your co-pay card. Please try again later, or call the LYBALVI Co-pay Savings Program at 1-855-820-9624 (8:00 AM-8:00 PM ET, Monday-Friday) for assistance.

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).

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?

Downloadable Resources
View Site for Bipolar 1 in Adults

Important Safety Information

LYBALVI may cause serious side effects, including increased risk of death in elderly people with dementia-related psychosis. LYBALVI increases the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LYBALVI is not approved for the treatment of people with dementia-related psychosis.

Do not take LYBALVI if you are taking opioids or are experiencing acute opioid withdrawal.

LYBALVI may cause serious side effects, including:
  • Stroke (cerebrovascular problems) in elderly people with dementia-related psychosis that can lead to death.
  • Opioid withdrawal. Do not
    take LYBALVI for at least 7 days after you stopped taking short-acting opioids and for at least 14 days after you stopped taking long-acting opioids. One of the medicines in LYBALVI (samidorphan) can cause opioid withdrawal that may be severe and cause hospitalization in people who are physically dependent on opioids. Talk to your healthcare provider if you have questions about the type of opioid you take.
  • Risk of life-threatening opioid overdose.
    You should not start taking opioids for at least 5 days after you stop treatment with LYBALVI. One of the medicines in LYBALVI (samidorphan) can increase your chance of having an opioid overdose that can cause death if you take opioids during treatment or within 5 days after stopping treatment with LYBALVI.
  • You can accidentally overdose in 2 ways:
    • LYBALVI blocks the effects of opioids, such as heroin, methadone, or opioid pain medicines.
      Do not
      take large amounts of opioids to try to overcome the opioid-blocking effects of LYBALVI. This can lead to serious injury, coma, or death.
    • After you take LYBALVI, its blocking effect slowly decreases and completely goes away over time. You may be more sensitive to the effects of opioids. If you have used opioid street drugs or opioid-containing medicines in the past, using opioids in amounts that you used before treatment with LYBALVI can lead to overdose or death.
  • It is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose.
  • You or someone close to you should get emergency medical help right away if you:
    • have trouble breathing
    • become very drowsy with slowed breathing
    • have slow, shallow breathing (little chest movement with breathing)
    • feel faint, very dizzy, confused, or have unusual symptoms
  • Tell your healthcare provider if you are taking LYBALVI before a medical procedure or surgery.
  • Neuroleptic malignant syndrome (NMS), a serious condition that can lead to death.
    Call your healthcare provider or go to the nearest hospital emergency room right away if you have some or all of the following signs and symptoms of NMS:
    • high fever
    • stiff muscles
    • confusion
    • sweating
    • changes in your breathing, pulse, heart rate, and blood pressure
  • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS):
    One of the medicines in LYBALVI (olanzapine) can cause DRESS which can cause death. Tell your healthcare provider right away if you develop any of the following symptoms of DRESS, including:
    • rash
    • swollen glands
    • liver problems
    • heart problems
    • fever
    • kidney problems
    • lung problems
  • Problems with your metabolism such as:
    • high blood sugar (hyperglycemia) and diabetes.
      Increases in blood sugar can happen in some people who take LYBALVI. Extremely high blood sugar can lead to coma or death. Your healthcare provider should check your blood sugar before you start and regularly during treatment with LYBALVI.
    • Call your healthcare provider if you have any of these symptoms of high blood sugar during treatment with LYBALVI:
      • feel very thirsty
      • feel very hungry
      • feel sick to your stomach
      • need to urinate more than usual
      • feel weak or tired
      • feel confused, or your breath smells fruity
    • increased fat levels (cholesterol and triglycerides) in your blood.
      Your healthcare provider should check the fat levels in your blood before you start and regularly during treatment with LYBALVI.
    • weight gain.
      You and your healthcare provider should check your weight before you start and often during treatment with LYBALVI.
  • Uncontrolled body movements (tardive dyskinesia).
    LYBALVI may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop taking LYBALVI. Tardive dyskinesia may also start after you stop taking LYBALVI.
  • Decreased blood pressure (orthostatic hypotension) and fainting.
    You may feel lightheaded or faint when you rise too quickly from a sitting or lying position.
  • Falls.
    LYBALVI may make you sleepy or dizzy, may cause a decrease in your blood pressure when changing position (orthostatic hypotension), and can slow your thinking and motor skills which may lead to falls that can cause fractures or other injuries.
  • Low white blood cell count.
    Your healthcare provider may do blood tests during the first few months of treatment with LYBALVI.
  • Difficulty swallowing
    that can cause food or liquid to get into your lungs.
  • Seizures (convulsions).
  • Problems controlling your body temperature so that you feel too warm.
  • Increased prolactin levels in your blood.
    Your healthcare provider may do blood tests to check your prolactin levels during treatment with LYBALVI.
The most common side effects of LYBALVI when used to treat people with schizophrenia include:
  • weight gain
  • dry mouth
  • sleepiness
  • headache
The most common side effects of LYBALVI when used alone to treat people with mixed or manic episodes that happen with bipolar I disorder include:
  • weakness
  • constipation
  • sleepiness
  • shaking
  • dry mouth
  • increased appetite
  • dizziness
The most common side effects of LYBALVI when used in combination with lithium or valproate to treat people with mixed or manic episodes that happen with bipolar I disorder include:
  • dry mouth
  • increased appetite
  • back pain
  • problems speaking
  • memory problems
  • weight gain
  • dizziness
  • constipation
  • mouth watering
  • numbness and tingling in your arm and legs
Do not drive a car, operate machinery, or do other dangerous activities until you know how LYBALVI affects you. LYBALVI may make you feel drowsy.

Avoid drinking alcohol during treatment with LYBALVI.

Avoid getting over-heated or dehydrated.

    • Do not
      exercise too much.
    • In hot weather, stay inside in a cool place if possible.
    • Stay out of the sun.
      Do not
      wear too much clothing or heavy clothing.
    • Drink plenty of water.
Before taking LYBALVI, tell your healthcare provider about all of your medical conditions, including if you:
  • have or had heart problems or a stroke
  • use or abuse street (illegal) drugs
  • have or had low or high blood pressure
  • have kidney problems
  • have diabetes or high blood sugar or a family history of diabetes or high blood sugar
  • have or have had high levels of total cholesterol, LDL cholesterol, or triglycerides or low levels of HDL cholesterol
  • have or had a low white blood cell count
  • have problems swallowing
  • have or had seizures (convulsions)
  • have or had problems with urination or prostate problems
  • have or had breast cancer
  • have or had constipation or a bowel obstruction
  • have or had high prolactin levels
  • are pregnant or plan to become pregnant. Talk to your healthcare provider about the risks to you and your unborn or newborn baby if you take LYBALVI during pregnancy.
  • are breastfeeding or plan to breastfeed. LYBALVI passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with LYBALVI.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

LYBALVI and other medicines may affect each other causing possible serious side effects.

LYBALVI may affect the way other medicines work, and other medicines may affect how LYBALVI works.

Especially tell your healthcare provider if you:
  • take opioids or have stopped taking opioids in the past 14 days
  • take or plan to take other olanzapine containing medicines

Your healthcare provider can tell you if it is safe to take LYBALVI with your other medicines. Do not start or stop any medicines while taking LYBALVI without first talking to your healthcare provider.

These are not all the possible side effects of LYBALVI.

Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Indications

LYBALVI is a prescription medicine which contains 2 medicines (olanzapine and samidorphan) used in adults:

  • to treat schizophrenia
  • alone for short-term (acute) or maintenance treatment of manic or mixed episodes that happen with bipolar I disorder
  • in combination with valproate or lithium to treat manic or mixed episodes that happen with bipolar I disorder

It is not known if LYBALVI is safe or effective in children.