Doctors prescribe Nuplazid (pimavanserin) to treat psychosis symptoms caused by Parkinson’s disease, like hallucinations and delusions. But this drug can be costly out of pocket.

That said, all Medicare Part D plans must cover drugs in specific categories, including antipsychotics. This requirement means that, in many cases, your Part D plan should cover Nuplazid.

Due to the new out-of-pocket cap for Part D, you may never pay more than $2,000, even for drugs in the highest tier. In many cases, you may pay far less.

If you’re above 65 years old and eligible for Medicare, read on to learn how much you may pay out of pocket for Nuplazid.

The wholesale cost of Nuplazid is $4,995 for a 30-count bottle. This cost is how much the manufacturer charges a wholesaler, like a pharmacy, to purchase the drug. The cost the pharmacy charges you out of pocket can largely depend on the wholesale cost.

If your Part D plan offers drug coverage, your plan can include a formulary of covered drugs divided into tiers. The tier Nuplazid falls into determines how much you pay out of pocket.

Before 2025, when your out-of-pocket expenses for drugs hit a certain amount, you entered the donut hole. As of this year, however, Medicare replaced the donut hole with a cap of $2,000 on your out-of-pocket expenses for drugs. Once you reach this limit, you may not pay any more.

According to the manufacturer’s website for Nuplazid, 9 in 10 people end up paying less than$10 out of pocket for this drug.

Also, as of this year, no Part D plan can charge you more than $590 for your deductible.

If you’re looking for additional ways to reduce your out-of-pocket cost for Nuplazid, you can consider the following options:

  • Extra Help: This program provides additional financial support for prescription drugs based on income and need.
  • Coupons: You can find coupons, such as this one from Optum Perks. Just note that you cannot combine these with insurance, so check whether your savings may be higher than under Part D.
  • Pharmaceutical assistance programs: These can be nationwide or state-based.

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Generally speaking, Medicare Part D covers prescription drugs, but whether your plan covers a drug depends on the plans available in your area. This plan availability varies because private insurers manage Medicare Part D plans.

While most Part D plans should generally cover Nuplazid, you may have to go through a prior authorization process to get coverage. Plans that don’t cover it must cover alternatives such as quetiapine (Seroquel) or clozapine (Clozaril). There’s no generic version for Nuplazid.

You can search for a Medicare Advantage plan with drug coverage instead of Part D.