OBJECTIVES:  Brexpiprazole, a serotonin-dopamine activity modulator, was approved in 2015 in the United States for the treatment of schizophrenia. This is the first opportunity to examine real-world adherence and treatment patterns in patients with schizophrenia treated with brexpiprazole and atypical antipsychotics (AAPs) in the long-term care (LTC) setting. METHODS: Longitudinal LTC pharmacy and outpatient medical claims data from 10-Jul-2015 to 03-Mar-2016 were used. Patients were included if they had a diagnosis for schizophrenia, were ≥18 years old, and newly initiated brexpiprazole or other AAPs (olanzapine, quetiapine, ziprasidone, risperidone, aripiprazole, or lurasidone). The index date was the date of first AAP fill. Patient characteristics and treatment history were measured in the 12 months pre-index. Post-index adherence was measured as variable medication possession ratio (MPR_v) among patients with ≥2 fills of the index medication. RESULTS:  77 patients on brexpiprazole and 21,403 patients on other AAPs (5,018 olanzapine; 4,638 quetiapine; 932 ziprasidone; 5,884 risperidone; 2,117 aripiprazole; 693 lurasidone) were identified. Mean ages (years±standard deviation) were 48±15.2 for brexpiprazole, 54±15.5 for aripiprazole, 50±14.2 for lurasidone, 56±15.6 for olanzapine, 56±15.4 for quetiapine, 57±14.8 for risperidone, and 52±14.4 for ziprasidone. Brexpiprazole was prescribed mainly by psychiatrists/psychologists (68%) while other AAPs, except lurasidone, were prescribed more by PCPs (olanzapine: 52%, quetiapine: 54%, ziprasidone: 50%, risperidone: 56%, aripiprazole: 49%, lurasidone: 41%). 96% of brexpiprazole patients were previously treated with ≥1 AAP compared to other AAPs (olanzapine: 56%, quetiapine: 65%, ziprasidone: 64%, risperidone: 49%, aripiprazole: 59%, and lurasidone: 72%). Mean MPR_v values were 94% in brexpiprazole, 93% in aripiprazole, and 95% in all other AAPs. CONCLUSIONS:  This is the first study to describe the use of brexpiprazole for schizophrenia in the LTC setting. Brexpiprazole was prescribed mainly by specialists, and most brexpiprazole patients were previously treated with AAPs. Adherence to brexpiprazole was similar to other AAPs.