Asenapine (Saphris, Secuado)

How Medicare covers it

Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Saphris (asenapine) treats schizophrenia in adults and bipolar I disorder, including acute manic or mixed episodes in adults and in children 10 to 17 years old, added treatment with lithium or valproate in adults, and maintenance treatment in adults.

What it is for, in depth

Asenapine is an antipsychotic medicine for adults with schizophrenia and for bipolar I disorder. For bipolar I disorder, it treats acute manic or mixed episodes in adults and in children ages ten to seventeen, it can be added to lithium or valproate in adults, and it is used for maintenance treatment in adults. It is thought to work by blocking dopamine and serotonin receptors in the brain, though the exact way it works is not known. It comes as sublingual tablets in 2.5 MG, 5 MG, and 10 MG strengths that dissolve under the tongue twice daily, and as a once-daily Secuado skin patch.

How it works

The exact way it works is not known, but it is thought to work by blocking dopamine D2 and serotonin 5-HT2A receptors in the brain.

How it is taken

It is a tablet that dissolves under the tongue, usually twice daily; do not split, crush, chew, or swallow it, and do not eat or drink for 10 minutes after a dose.

Common side effects

In schizophrenia the most common side effects were restlessness (akathisia), numbness of the mouth, and sleepiness. In bipolar mania they also included dizziness and movement symptoms such as stiffness or shaking.

Serious warnings

This drug has a BOXED WARNING: older adults with dementia-related psychosis treated with antipsychotic drugs have a higher risk of death, and Saphris is not approved for that use. Other serious warnings include neuroleptic malignant syndrome, tardive dyskinesia, metabolic changes such as high blood sugar and weight gain, low blood pressure and fainting, falls, low white blood cell counts, and QT heart interval prolongation.

Boxed warning

Older adults with dementia-related psychosis who take antipsychotic drugs like Saphris have an increased risk of death, and Saphris is not approved for treating dementia-related psychosis.

Who should be careful

It must not be used in severe liver impairment. Older patients, people with heart disease, low blood pressure, diabetes, seizures, swallowing problems, or a history of low white blood cell counts need special care, and it can cause sleepiness and falls.

Major interactions

Blood pressure medicines may have a stronger lowering effect with Saphris. Strong CYP1A2 blockers such as fluvoxamine can raise asenapine levels, and paroxetine dose should be cut in half when used together because Saphris raises paroxetine levels.

Why it is in its tier

Asenapine is most often placed on Tier 4, the non-preferred tier, where cost share is higher than on the lower preferred tiers. It is listed by 100.0% of Part D plans in the CMS aggregation, and 84.55% of those listing plans place it on Tier 4. That high placement fits a brand-name antipsychotic sold as Saphris and Secuado, rather than a low-cost preferred generic. The CMS dashboard shows average spending per beneficiary of $1735.51, which is a CMS program average, not a copay or what one person pays. Individual plans vary, so readers should check their own plan directly before filling a prescription. Readers should not assume the most common tier will be the tier in their own coverage.

Sources

• SAPHRIS (ASENAPINE MALEATE) TABLET [ALLERGAN, INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Asenapine

What official patient guides say

Asenapine is a sublingual tablet that dissolves under your tongue, taken twice a day at the same times daily. Do not take it out of its package until just before you take it, and make sure your hands are dry when you handle it. Remove it following the package directions, without pushing it through the pack or breaking it, then place it under your tongue and let it dissolve — do not swallow, split, chew, or crush it, and do not eat or drink for 10 minutes after it dissolves. Keep taking it even if you feel well, and do not stop without talking to your doctor. If you miss a dose, take it as soon as you remember it, unless it is almost time for the next dose — then skip it and do not take a double dose. Store it in its container, tightly closed, at room temperature away from heat and moisture, out of children's reach.

Source: MedlinePlus — Asenapine

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 2.36268 per unit (ASENAPINE 10 MG TABLET SL) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Asenapine (Saphris, Secuado) — 100% of plans. Most of those plans put it on Tier 4: 4,646 plans, 84.5% of the plans that list it. Other plans place it on Tier 2 (400 plans), Tier 1 (365 plans) or Tier 3 (84 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 4; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 4; Aetna Medicare Value Plus (PPO) puts it on Tier 4. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.