Does Florida Blue Medicare, INC. require prior authorization for Caplyta?
Prior authorization for Caplyta differs across Florida Blue Medicare, INC.'s Medicare Part D plans and product strengths — 3 of 3 Caplyta products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.
Some plans require authorization and others do not. The member's specific plan decides.
- Prior authorization requirements differ across this payer's plans: 2 of 15 covering plans require it. Check the specific plan the member is enrolled in — the plan name and contract number are on their insurance card.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| lumateperone 42 MG Oral Capsule [Caplyta]2275613 | 15 / 15 | 2 | 0 | 15 | Varies by plan |
| lumateperone 10.5 MG Oral Capsule [Caplyta]2607531 | 15 / 15 | 2 | 0 | 15 | Varies by plan |
| lumateperone 21 MG Oral Capsule [Caplyta]2607535 | 15 / 15 | 2 | 0 | 15 | Varies by plan |
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 |
|---|---|---|---|---|---|
| BlueMedicare Classic (HMO) | H1035-017 | 5 | No | No | Yes |
| BlueMedicare Classic (HMO) | H1035-019 | 5 | No | No | Yes |
| BlueMedicare Classic (HMO) | H1035-020 | 5 | No | No | Yes |
| BlueMedicare Classic (HMO) | H1035-021 | 5 | No | No | Yes |
| BlueMedicare Preferred (HMO) | H1035-052 | 5 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-022 | 5 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-025 | 5 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-026 | 5 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-033 | 5 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-034 | 5 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-043 | 5 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-045 | 5 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-048 | 5 | No | No | Yes |
| FHCP Medicare Classic (HMO) | H1035-040 | 5 | Yes | No | Yes |
| FHCP Medicare Rx Plus (HMO-POS) | H1035-002 | 5 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
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- 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.