Does Atrio Health Plans require prior authorization for Caplyta?
Atrio Health Plans does not require prior authorization for Caplyta on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- No prior authorization is filed, but step therapy applies on 12 of 12 covering plans — the plan requires another drug be tried first.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| lumateperone 42 MG Oral Capsule [Caplyta]2275613 | 12 / 12 | 0 | 12 | 12 | No prior authorization |
| lumateperone 10.5 MG Oral Capsule [Caplyta]2607531 | 12 / 12 | 0 | 12 | 12 | No prior authorization |
| lumateperone 21 MG Oral Capsule [Caplyta]2607535 | 12 / 12 | 0 | 12 | 12 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — lumateperone 42 MG Oral Capsule [Caplyta]
Caplyta has 3 products in the corpus; this table is for lumateperone 42 MG Oral Capsule [Caplyta], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| ATRIO Choice Rx (PPO) | H6743-001 | 5 | No | Yes | Yes |
| ATRIO Choice Rx (PPO) | H6743-007 | 5 | No | Yes | Yes |
| ATRIO Choice Rx (PPO) | H6743-025 | 5 | No | Yes | Yes |
| ATRIO Choice Rx (PPO) | H7006-007 | 5 | No | Yes | Yes |
| ATRIO Choice Rx (PPO) | H7006-018 | 5 | No | Yes | Yes |
| ATRIO Prime Rx (HMO) | H5995-004 | 5 | No | Yes | Yes |
| ATRIO Prime Rx (PPO) | H6743-026 | 5 | No | Yes | Yes |
| ATRIO Prime Rx (PPO) | H6743-028 | 5 | No | Yes | Yes |
| ATRIO Prime Rx (PPO) | H6743-030 | 5 | No | Yes | Yes |
| ATRIO Special Needs Plan (HMO D-SNP) | H3814-007 | 1 | No | Yes | Yes |
| ATRIO Special Needs Plan (HMO D-SNP) | H3814-030 | 1 | No | Yes | Yes |
| ATRIO Support Rx (PPO C-SNP) | H7006-022 | 5 | No | Yes | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Caplyta at other payers
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.