Support
Access Support for Your Patients
LYBALVI (olanzapine and samidorphan) Co-pay Savings Program
Now with no activation process needed.
Commercially insured eligible patients could pay:
$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.*

LYBALVI Care Support provides 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:
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.
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.
Prior authorizations are commonly obtained for LYBALVI
LYBALVI Prior Authorizations Submitted Through CoverMyMeds:
70%
average
approval rate1*
Time to a decision
<24 hours
for 87% of submissions, on average2†
*Data shown is based on LYBALVI data from October 2021 to September 2022.
†Data shown is based on LYBALVI data from February 2022 to February 2023.
Data is not representative of all prior authorization submissions. Prior authorization through CoverMyMeds is not a guarantee of approval.
Supporting your patients with prior authorizations and appeals
- 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
Additional prior authorization & appeals assistance
Checklist for Letters of Medical Necessity and Appeals
Provided to help facilitate communications with health insurance companies to support a prior authorization, a formulary exception request, a medical exception, or an appeal of a denied claim for coverage of LYBALVI.
DownloadMedicare Appeals and Exceptions Process Brochure
Information on the process for appeals of both Original Medicare and Part D coverage decisions.
DownloadPrior Authorization Flashcard
Information you may want to consider including when completing a prior authorization, including ICD-10-CM diagnosis codes.
DownloadICD-10-CM Diagnosis Codes for Schizophrenia Applicable to LYBALVI3
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 Disorder Applicable to LYBALVI3
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.
Additional LYBALVI access resources for healthcare professionals
Find out more information about the various services and resources available to help support access for LYBALVI patients.
Supporting Your Patients’ Access to LYBALVI Treatment Brochure
Information on prior authorizations, letters of medical necessity, appealing a claim denial, and more.
DownloadAccess Support Q&A: A Guide for Healthcare Professionals
Answers to your access questions, including those about insurance coverage, prior authorization, co-pay, and more.
DownloadLow Income Subsidy Guide
Information on the Medicare Part D Extra Help program that may help eligible patients reduce out-of-pocket costs for their prescription drugs.
Download