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 below for full Program Terms and Conditions
For illustrative purposes only.
For commercially insured eligible patients
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Download your Co-pay Savings Card below
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- 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.
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.
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).