Support
Support for your patients
LYBALVI (olanzapine and samidorphan) Co-pay Savings Program
Commercially insured eligible patients
$0 for the first 3 fills of LYBALVI*
After the first 3 fills, each refill may cost as little as $20 with a maximum savings of $450 per 30‑day supply.*
*Maximum savings limit applies; patients’ out-of-pocket expenses may vary. Maximum 30-day supply per fill for the first 3 fills. Beginning at fill 4, a maximum savings of $450 per 30-day supply will be provided towards the cost of the LYBALVI prescription. Health plan requirements for a prior authorization and/or step therapies must be attempted prior to using this co-pay offer. Patient must be 18 years of age or older and have a prescription for LYBALVI. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Offer not valid for cash paying patients. Please see full Program Terms and Conditions.
*Maximum savings limit applies; patients’ out-of-pocket expenses may vary. Maximum 30-day supply per fill for the first 3 fills. Beginning at fill 4, a maximum savings of $450 per 30-day supply will be provided towards the cost of the LYBALVI prescription. Health plan requirements for a prior authorization and/or step therapies must be attempted prior to using this co-pay offer. Patient must be 18 years of age or older and have a prescription for LYBALVI. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Offer not valid for cash paying patients. Please see full Program Terms and Conditions.
LYBALVI Care Support provides patient support services to help patients access treatment

To enroll your patients in LYBALVI Care Support and to learn more about these services, call 1‑844‑LYBALVI (1‑844‑592‑2584), Monday through Friday, 9 AM to 8 PM ET.
LYBALVI Care Support offers
these benefits:
PATIENT ACCESS SUPPORT
LYBALVI Care Support provides general coverage information and can conduct a full benefit investigation, including a written summary of benefits, usually within 24 hours for enrolled patients.
PATIENT ASSISTANCE
PROGRAM (PAP)
Provides qualifying uninsured patients who meet PAP eligibility requirements access to LYBALVI treatment at no charge for up to 12 months. Certain restrictions apply.
Patient Assistance Program EligibilityENROLL YOUR PATIENTS IN LYBALVI CARE SUPPORT
DownloadEnrollment Form
Download Enrollment Form Guide
for information on completion of the form.
Further resources
PRIOR AUTHORIZATION
& APPEALS ASSISTANCE
If a prior authorization or appeal is required, you may be able to support your patient’s coverage request using the checklist below or through CoverMyMeds®.
Prior authorization support for LYBALVI is available through CoverMyMeds®
CoverMyMeds is a third-party platform external to Alkermes
- Supports the prior authorization process online with plan-specific forms and information
- Healthcare provider offices can quickly find and submit a prior authorization via the healthcare provider portal or via certain EHR platforms
- Pharmacists can also send a prior authorization request to your office for you to complete and submit
- Health plans can provide determinations via the CoverMyMeds portal to both your office and the local pharmacy
- CoverMyMeds live agents can help you navigate the appeal process by providing health plan-specific appeal forms for you to complete and return to the plan, in the event coverage is denied.
- Available at no cost to your office
For questions, call 1-866-452-5017 or visit www.covermymeds.com for more information.
CoverMyMeds® is a registered trademark of CoverMyMeds LLC.
ADDITIONAL PRIOR AUTHORIZATION
& APPEALS ASSISTANCE
Medical Necessity and Appeals
Medicare Appeals and Exceptions
Process Brochure
Prior Authorization Flashcard
Considerations when using ICD-10-CM diagnosis codes
Claims submitted for LYBALVI should include at least one ICD-10-CM diagnosis code to indicate the patient’s condition. Specific diagnosis codes should represent the condition as supported by the patient’s medical record. The diagnosis codes listed below may apply to patients for whom LYBALVI may be appropriate.
ICD-10-CM Diagnosis Codes for Schizophrenia1
F20.0
Paranoid-schizophrenia
F20.1
Disorganized schizophrenia
F20.2
Catatonic schizophrenia
F20.3
Undifferentiated schizophrenia
F20.5
Residual schizophrenia
F20.89
Other schizophrenia
F20.9
Schizophrenia, unspecified
IMPORTANT: Healthcare providers are responsible for keeping current and complying with all applicable coverage requirements and for the selection of diagnosis and procedure codes that accurately reflect their patient’s condition and the services rendered.
Healthcare providers also are responsible for the accuracy of all claims and related documentation submitted for reimbursement. Additional insurance requirements may apply and healthcare providers should always contact the insurer directly to obtain complete and current information regarding coverage of LYBALVI.
Alkermes does not guarantee coverage or reimbursement. Under no circumstances will Alkermes, Inc., or its affiliates, employees, consultants, agents or representatives be liable for costs, expenses, losses, claims, liabilities or other damages that may arise from, or be incurred in connection with, the information provided here or any use thereof.
ICD-10-CM Diagnosis Codes for Bipolar I Disorder1
F31.10
Bipolar disorder, current episode manic without psychotic features, unspecified
F31.11
Bipolar disorder, current episode manic without psychotic features, mild
F31.12
Bipolar disorder, current episode manic without psychotic features, moderate
F31.13
Bipolar disorder, current episode manic without psychotic features, severe
F31.2
Bipolar disorder, current episode manic severe with psychotic features
F31.60
Bipolar disorder, current episode mixed, unspecified
F31.61
Bipolar disorder, current episode mixed, mild
F31.62
Bipolar disorder, current episode mixed, moderate
F31.63
Bipolar disorder, current episode mixed, severe, without psychotic features
F31.64
Bipolar disorder, current episode mixed, severe, with psychotic features
F31.70
Bipolar disorder, currently in remission, most recent episode unspecified
F31.73
Bipolar disorder, in partial remission, most recent episode manic
F31.74
Bipolar disorder, in full remission, most recent episode manic
F31.77
Bipolar disorder, in partial remission, most recent episode mixed
F31.78
Bipolar disorder, in full remission, most recent episode mixed
IMPORTANT: Healthcare providers are responsible for keeping current and complying with all applicable coverage requirements and for the selection of diagnosis and procedure codes that accurately reflect their patient’s condition and the services rendered.
Healthcare providers also are responsible for the accuracy of all claims and related documentation submitted for reimbursement. Additional insurance requirements may apply and healthcare providers should always contact the insurer directly to obtain complete and current information regarding coverage of LYBALVI.
Alkermes does not guarantee coverage or reimbursement. Under no circumstances will Alkermes, Inc., or its affiliates, employees, consultants, agents or representatives be liable for costs, expenses, losses, claims, liabilities or other damages that may arise from, or be incurred in connection with, the information provided here or any use thereof.
ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification.
LYBALVI ACCESS RESOURCES FOR HEALTHCARE PROFESSIONALS
Find out more information about the various services and resources available to help support access for LYBALVI patients.
Reference: 1. AAPC. ICD-10-CM Expert. Diagnosis codes for providers & facilities. Chapter 5: Mental, behavioral and neurodevelopmental disorders (F01-F99). 2022.