| Schizophrenia
Lybalvi vs Rexulti
Side-by-side clinical, coverage, and cost comparison for schizophrenia.Deep comparison between: Lybalvi vs Rexulti with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsRexulti has a higher rate of injection site reactions vs Lybalvi based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Rexulti but not Lybalvi, including UnitedHealthcare
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Category
Lybalvi
Rexulti
At A Glance
Oral
Once daily
Atypical antipsychotic + opioid antagonist
Oral
Once daily
Atypical antipsychotic
Indications
- Schizophrenia
- Bipolar I disorder
- Major Depressive Disorder
- Schizophrenia
- Agitation in Dementia
Dosing
Schizophrenia Initiate at 5 or 10 mg/10 mg orally once daily; recommended dose 10, 15, or 20 mg/10 mg once daily; maximum 20 mg/10 mg once daily.
Bipolar I disorder - monotherapy (manic or mixed episodes) Initiate at 10 or 15 mg/10 mg orally once daily; recommended dose 10, 15, or 20 mg/10 mg once daily; maximum 20 mg/10 mg once daily.
Bipolar I disorder - adjunct to lithium or valproate Initiate at 10 mg/10 mg orally once daily; recommended dose 10, 15, or 20 mg/10 mg once daily; maximum 20 mg/10 mg once daily.
Major Depressive Disorder Start 0.5 mg or 1 mg orally once daily; titrate to target 2 mg once daily; maximum 3 mg once daily.
Schizophrenia Adults: start 1 mg once daily, titrate to target 2-4 mg once daily (max 4 mg); pediatric patients 13-17 years: start 0.5 mg once daily, titrate to target 2-4 mg once daily (max 4 mg).
Agitation in Dementia Start 0.5 mg orally once daily; titrate to target 2 mg once daily; maximum 3 mg once daily.
Contraindications
- Current opioid use
- Acute opioid withdrawal
- Known hypersensitivity to brexpiprazole or any excipient (reactions include rash, facial swelling, urticaria, and anaphylaxis)
Adverse Reactions
Most common (>=5%) Weight increased, somnolence, dry mouth, headache
Serious Neuroleptic malignant syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS), metabolic changes (hyperglycemia, dyslipidemia, weight gain), tardive dyskinesia, orthostatic hypotension and syncope, leukopenia, neutropenia, agranulocytosis, dysphagia, seizures
Postmarketing Anaphylactoid reaction, angioedema, cholestatic or mixed liver injury, hepatitis, jaundice, diabetic coma, diabetic ketoacidosis, DRESS, fecal incontinence, hyperlipidemia, neutropenia, pancreatitis, priapism, rash, rhabdomyolysis, SIADH, somnambulism, stuttering, venous thromboembolic events
Most common (>=5%) weight increased, akathisia, headache, somnolence, insomnia
Serious neuroleptic malignant syndrome, tardive dyskinesia, metabolic changes, leukopenia, neutropenia, agranulocytosis, orthostatic hypotension, falls, seizures, body temperature dysregulation
Postmarketing neuroleptic malignant syndrome
Pharmacology
The efficacy of olanzapine in schizophrenia and bipolar I disorder may be mediated through combined dopamine and serotonin type 2 (5HT2) antagonism; samidorphan is an opioid antagonist whose mechanism could be mediated through mu-, kappa-, and delta-opioid receptor antagonism.
Brexpiprazole is an atypical antipsychotic whose efficacy may be mediated through partial agonist activity at serotonin 5-HT1A and dopamine D2 receptors combined with antagonist activity at serotonin 5-HT2A receptors; the exact mechanism of action in the approved indications is unknown.
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Most Common Insurance
Anthem BCBS
Lybalvi
- Covered on 5 commercial plans
- PA (1/12) · Step Therapy (6/12) · Qty limit (10/12)
Rexulti
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (5/12) · Qty limit (11/12)
UnitedHealthcare
Lybalvi
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (1/8) · Qty limit (1/8)
Rexulti
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (6/8)
Humana
Lybalvi
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Rexulti
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: Schizophrenia - Medicare Access
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
Cost estimate not availableHealthWell: Cancer-Related Behavioral Health
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.