Cost Is One of the Biggest Barriers to Rexulti Adherence

You've determined that Rexulti (Brexpiprazole) is the right medication for your patient. The clinical evidence supports your decision. But when your patient gets to the pharmacy and sees the price tag — approximately $1,516 per month at list price — the prescription may never get filled.

Medication non-adherence due to cost is one of the most common and preventable problems in mental health treatment. For atypical antipsychotics like Rexulti, where consistent dosing is critical for efficacy, even a single month's gap can set treatment back significantly.

This guide covers the savings programs, assistance options, and clinical alternatives available to help your patients access and afford Rexulti — and practical strategies for integrating cost conversations into your workflow.

What Your Patients Are Actually Paying

The cost of Rexulti varies widely depending on insurance coverage:

• Wholesale Acquisition Cost (WAC): $1,515.69/month (as of January 2025)
• Commercial insurance with formulary coverage: Copays typically range from $30 to $100+, depending on the plan's tier placement. Many plans require prior authorization or step therapy.
• Medicare Part D: Rexulti is covered by most Part D plans but may be on a specialty tier. In 2026, the Part D out-of-pocket cap of $2,100/year will help, but patients may still face high initial costs before reaching catastrophic coverage.
• Uninsured cash price: $1,200 to $1,600+/month at most retail pharmacies
• With discount cards (GoodRx, SingleCare): Still typically $1,000+/month without insurance — discount cards have limited impact on expensive brand-name medications.

The bottom line: without intervention, many patients face unaffordable costs that lead to prescription abandonment or poor adherence.

Manufacturer Savings Programs

Rexulti Savings Card (Commercially Insured Patients)

Otsuka offers a manufacturer savings card that can reduce out-of-pocket costs to as little as $0 for eligible patients. Key details:

• Eligibility: Commercially insured patients with a valid Rexulti prescription
• Coverage: Applies to copays, co-insurance, and pharmacy deductibles
• Limits: Up to 13 uses per year (resets annually)
• Not available for: Medicare, Medicaid, TRICARE, or other government-funded insurance
• Enrollment: Patients can enroll at rexulti.com/savings-cost or call Otsuka Patient Support at 1-833-468-7852

This is the single most impactful savings tool for commercially insured patients. Consider having your staff proactively provide savings card information at the time of prescribing.

Otsuka Patient Support (Uninsured/Underinsured Patients)

For patients without commercial insurance, Otsuka's patient support program may provide Rexulti at reduced or no cost:

• Visit otsukapatientsupport.com/rexulti
• Call 1-833-468-7852
• Assistance is based on financial need and insurance status

Encourage your uninsured patients to apply — these programs are underutilized, and many eligible patients never learn about them.

Coupon and Discount Cards

While discount cards are less effective for expensive brand-name drugs, they can still provide some relief in specific situations:

• GoodRx — May reduce cash price at certain pharmacies; most useful for patients filling generic Brexpiprazole
• SingleCare — Similar to GoodRx; compare prices between the two
• RxSaver — Aggregates discount pricing from multiple sources
• BuzzRx — Another option for comparing pharmacy prices

For patients who can access generic Brexpiprazole (FDA-approved since August 2022), discount cards become significantly more useful, as generic pricing is substantially lower than brand.

Refer patients to Medfinder's guide to saving money on Rexulti for a comprehensive list of options.

Generic Alternatives and Therapeutic Substitution

Generic Brexpiprazole

Generic Brexpiprazole was approved by the FDA in August 2022. While not universally available at all pharmacies, it represents a meaningful cost reduction when accessible. Ask patients to check availability with their pharmacy or use Medfinder to locate pharmacies carrying the generic.

Therapeutic Alternatives

When cost is prohibitive and savings programs don't fully bridge the gap, consider therapeutic substitution with a similar medication that has a lower cost profile:

• Aripiprazole (Abilify) — Available as a generic. Similar mechanism of action (partial D2 agonism). Widely available and significantly cheaper. The most common switch from Rexulti.
• Quetiapine (Seroquel) — Available as a generic. Different receptor profile but used for similar indications. More sedating, which may or may not be desirable.
• Olanzapine/Fluoxetine (Symbyax) — Available as a generic combination. Approved for treatment-resistant depression.
• Cariprazine (Vraylar) — Brand-name only and similarly expensive, but may be covered differently by certain insurance plans.

Switching from Rexulti should always be a clinical decision weighing efficacy, tolerability, and patient preference alongside cost. For a clinical comparison, see our article on alternatives to Rexulti.

Building Cost Conversations into Your Workflow

Many providers find it difficult to raise the topic of medication cost, but proactive conversations significantly improve adherence. Here are practical strategies:

At the Point of Prescribing

• Mention cost upfront: "Rexulti can be expensive depending on your insurance. Let me make sure we set you up with savings options."
• Check formulary status: If your EHR integrates formulary data, verify coverage before prescribing. This prevents surprises at the pharmacy counter.
• Pre-populate savings card information: Have printed cards or QR codes for the Rexulti savings card available in your clinic.
• Consider prior authorization proactively: Many plans require PA for Rexulti. Submitting it at the time of prescribing (rather than waiting for a pharmacy rejection) reduces delays.

At Follow-Up Visits

• Ask about cost barriers: "Have you had any trouble filling your Rexulti prescription?" or "Is the cost manageable?"
• Monitor for non-adherence signals: Missed refills, dose-stretching, and symptom worsening can all indicate cost-related non-adherence.
• Re-evaluate alternatives periodically: If a patient is struggling with cost, revisit whether a generic alternative would be appropriate.

Leverage Your Support Staff

• Train medical assistants and front-desk staff to provide savings card information
• Designate someone in your practice to handle prior authorizations and patient assistance applications
• Direct patients to resources like Medfinder for Providers for real-time pharmacy stock and savings tools

Additional Resources for Your Practice

• Otsuka Patient Support: 1-833-468-7852 | otsukapatientsupport.com/rexulti
• NeedyMeds: needymeds.org — Comprehensive database of patient assistance programs
• RxAssist: rxassist.org — Directory of manufacturer assistance programs
• Medicare Extra Help/LIS: For patients with limited income on Medicare Part D, the Low-Income Subsidy can dramatically reduce costs
• Medfinder for Providers: medfinder.com/providers — Help patients find pharmacies with Rexulti in stock

Final Thoughts

Rexulti is an effective medication that can make a real difference for patients with depression, schizophrenia, and Alzheimer's-related agitation. But effectiveness means nothing if patients can't afford to take it consistently.

By proactively connecting patients with manufacturer savings programs, monitoring for cost-related non-adherence, and being willing to discuss therapeutic alternatives when needed, you can help ensure that cost doesn't become the reason your patient's treatment fails.

For more provider resources on Rexulti, including shortage updates and pharmacy stock tools, visit Medfinder for Providers.