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The Costs of Schizophrenia

Medically Reviewed by Smitha Bhandari, MD on February 26, 2021

If you have been diagnosed with schizophrenia, it’s vital to anticipate both the health and financial impact. Schizophrenia is a chronic condition that can be debilitating and make it hard to maintain your quality of life. Even if you get high-quality treatment, relapses are common.

What’s more, schizophrenia can lead to a significant financial burden. But you can plan for those costs based on where they typically arise and then start preparing today.

Medications

Prescription medications (especially anti-psychotic drugs) are the most important component of your schizophrenia treatment. Your psychiatrist will try prescribing different medications at different doses, or combinations, to achieve the best result at the lowest possible dose. It is important to shoot for the lowest effective dose because schizophrenia medications can have serious side effects.

You can take anti-psychotic medications either daily in tablet or liquid forms, or once or twice per month through injections. Your treatment may include one or more drugs from the following categories:

Second-generation anti-psychotics: These newer medications have a lower risk of side effects.

As with other schizophrenia medications, these second-generation anti-psychotic drugs vary widely in cost but can be quite expensive. For example, online prices for a 30-tablet prescription range from $190 for Seroquel to $1,415 for lurasidone. After a 30% insurance copay, your out-of-pocket might range from $57 to $424.50.

Tip: Compare prices among local pharmacies and online. You also can check on medication assistance programs offered by many pharmaceutical companies.

First-generation antipsychotics: These older medications carry a greater risk of side effects. But they are less expensive than second-generation medications, especially if you take a generic version. For example, the cheapest online generic price for the following medications is $14.16 for haloperidol.

Injectable antipsychotics: You take these medications with a shot every 2-4 weeks, which some people prefer to daily tablets.

These injectable medications range in price online from $182 for fluphenazine decanoate to $3,079 for Invega Sustenna (after your 30% copay, the range is $54.60 to $923.70).

Psychotherapy

Most people with schizophrenia regularly attend therapy sessions with a psychiatrist or psychologist. These sessions aim to improve your coping skills or cognitive abilities.

Session fees vary widely based on the therapist’s experience, where you live, and other factors. According to Psychology Today, the cost is usually between $100 and $200 per session in the U.S. The federal Affordable Care Act requires private health insurance plans to cover mental health care; typical co-pays are $30 to $50 per session, after which insurance pays 50% to 80%.

Medicare Part B also covers psychotherapy, but state Medicaid plans may pay only for your initial evaluation and not for ongoing treatment.

Other Therapies

People with schizophrenia can benefit greatly from family therapy, vocational rehabilitation, coordinated specialty care (CSC) for early-stage schizophrenia, or assertive community treatment (ACT) if you are at risk of repeat hospitalizations or homelessness.

But you may need a doctor’s referral before health insurance will cover these therapies, which can cost anywhere from $65 to $200 an hour. If you don’t have insurance, look for community organizations that offer individual or group therapy for free.

Tips: Helpful resources include:

  • The U.S. Substance Abuse and Mental Health Services Administration’s “Early Serious Mental Health Treatment Locator”
  • The National Alliance on Mental Illness’s “NAMI Family Support Group” page

Hospitalization and Brain Stimulation Therapy

When symptoms become particularly intense, you may need hospitalization to protect your health and safety. Also, if medications alone are not successful enough, doctors may recommend one of several brain stimulation therapies.

The most used of those therapies by people with schizophrenia is electroconvulsive therapy, or ECT. An ECT session costs anywhere from $300 to $1,000 in the U.S., and regular sessions can hike the annual bill to $10,000 or more. Fortunately, most private health insurance plans cover ECT treatment, as do Medicare and Medicaid.

Support for Daily Living

People with schizophrenia sometimes must take temporary leave from their jobs or claim disability when their symptoms get really bad. And at some point, you may need help with daily tasks like transportation, shopping, and personal finances. A family member could help; or check your health plan to see if it covers a caregiver’s services. If you need to pay a lawyer, financial planner, or CPA to handle your finances, insurance doesn’t cover their fees.

Take Steps Today

Don’t let the financial burdens of schizophrenia interfere with your treatment and recovery. Research the costs involved, plan for each of them, and take steps today to start to manage them if you can.

WebMD Medical Reference

Sources

SOURCES:

PharmacoEconomics: “The Cost of Relapse in Schizophrenia.”

Journal of Clinical Psychiatry: “The Economic Burden of Schizophrenia in the United States in 2013.”

Mayo Clinic: “Schizophrenia.”

American Journal of Managed Care: “Schizophrenia: Opportunities to Improve Outcomes and Reduce Economic Burden Through Managed Care.”

National Alliance of Mental Illness: “Schizophrenia.”

National Institute of Mental Health: “Schizophrenia,” “Burden of Schizophrenia.”

Psychology Today: “Cost and Insurance Coverage.”

U.S. Department of Health and Human Services: “Does the Affordable Care Act cover individuals with mental health problems?”

Medicare.gov: “Mental health care (outpatient).”

American Psychological Association: “Medicaid and psychology.”

Good Therapy.org: “How much does therapy cost?”

Mental Health America: “What Do I Need to Know About My Insurance Benefits?”

Journal of the American Medical Association - Psychiatry: “Cost-Effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States.”

John M. Eisenberg Center for Clinical Decisions and Communications Science: “Therapies for Treatment-Resistant Depression: A Review of the Research.”

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