Lithium citrate

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

Bipolar I disorder: treatment of acute manic and mixed episodes, and maintenance treatment to prevent future episodes, in patients 7 years and older. This package is the liquid (citrate) form.

What it is for, in depth

Lithium has been the reference mood stabilizer for bipolar disorder for more than half a century and remains one of the few treatments shown to reduce suicide risk in bipolar illness. The liquid citrate form is used when patients cannot swallow tablets, need very fine dose adjustments, or are children. The gap between a helpful level and a toxic level is small, so treatment is built around regular blood levels, steady salt and fluid intake, and care with interacting drugs such as diuretics and NSAIDs.

How it works

Lithium is a mood stabilizer. Exactly how it works is not fully known; it changes signaling inside brain cells in ways that calm manic episodes and help prevent both manic and depressive relapses.

How it is taken

An oral liquid measured carefully with a dosing device, usually taken in 2-3 divided doses a day with food; regular blood tests for lithium level, kidney function, and thyroid function are part of treatment.

Common side effects

['Increased thirst and urination', 'Fine hand tremor', 'Nausea or loose stools, usually early', 'Weight gain', 'Tiredness']

Serious warnings

['Lithium toxicity, which can occur at blood levels close to the treatment range: coarse tremor, vomiting, diarrhea, confusion, and unsteady walking are warning signs (see boxed warning)', 'Long-term kidney damage and increased urination with chronic use', 'Thyroid and parathyroid problems with long-term use']

Boxed warning

Lithium toxicity: lithium toxicity is closely related to serum lithium levels and can occur at doses close to therapeutic levels. Facilities for prompt and accurate serum lithium determinations should be available before starting therapy.

Who should be careful

['People with kidney disease or heart disease', 'People at risk of dehydration from vomiting, diarrhea, fever, or heavy sweating', 'People on low-salt diets', 'Anyone who is pregnant or breastfeeding, because lithium needs specialist management']

Major interactions

['Water pills (diuretics), which raise lithium levels and toxicity risk', 'NSAID pain relievers and ACE inhibitors/ARBs, which also raise lithium levels', 'Large changes in salt intake or caffeine, which shift lithium levels', 'Other drugs that affect serotonin or the nervous system']

Cost and saving notes

Lithium citrate solution is an old, inexpensive generic, but the liquid form is sometimes priced higher than lithium carbonate tablets or capsules. If your plan prices the solution high, ask your prescriber whether a solid form is acceptable, or request a tier exception. The blood tests lithium requires are medical care, billed outside the drug benefit. Extra Help can reduce drug costs if you qualify. The 2027 Part D out-of-pocket cap is $2,400 for the year, and the Medicare Prescription Payment Plan can spread that cost across the year.

Why it is in its tier

Lithium citrate sits on Tier 4 in 53.13% of the plans that list it (2912 of 5481 listing plans). Tier 4 is the non-preferred tier — higher copays or coinsurance. The data-visible drivers: It is a generic product, and the CMS dashboard puts its average Part D spending at about $424 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. It is listed by 99.75% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• LITHIUM (LITHIUM CITRATE) SOLUTION [PRECISION DOSE, INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus Drug Information

What official patient guides say

Take the liquid (solution) by mouth in divided doses during the day, at around the same times every day, exactly as directed on your prescription label; do not take more or less of it or take it more often than your doctor prescribed. It may take 1 to 3 weeks or longer to feel the full benefit, so keep taking it even if you feel well, and do not stop taking it without talking to your doctor. If you miss a dose, take it as soon as you remember it; however, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Keep all appointments with your doctor and the laboratory; your doctor will order certain lab tests to check your response to lithium. Follow a proper diet during treatment, including the right amounts of fluid and salt; your doctor will give you specific directions about the diet that is right for you, so follow them carefully, and talk to your doctor about drinks that contain caffeine, such as tea, coffee, cola, or chocolate milk. Store the liquid in the container it came in, tightly closed and out of reach of children, at room temperature and away from excess heat and moisture, not in the bathroom.

Source: MedlinePlus Drug Information

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 $0.4424 per unit (LITHIUM 8 MEQ/5 ML SOLUTION) — about $13.27 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 2026-11-08

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,481 list Lithium citrate — 99.8% of plans. Most of those plans put it on Tier 4: 2,912 plans, 53.1% of the plans that list it. Other plans place it on Tier 3 (1,398 plans), Tier 2 (756 plans) or Tier 1 (415 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.