OBJECTIVE: To compare the health care utilization and costs between patients with a diagnosis of bipolar I disorder with psychotic symptoms (BPP) to patients with bipolar I disorder without psychotic symptoms (BPO). METHODS: We conducted a retrospective, independent group analysis using pharmacy and medical claims from a large national managed care database. Patients in each cohort were identified based on their first claim for a bipolar diagnosis during the 2003 calendar year. T-tests and chi-square tests were used to compare variables between the two groups. RESULTS: Of the 8221 patients who met study criteria, 7.9% of the BPP group (n=5108) had at least one mental health-related hospitalization, compared to 4.0% of the BPO group (n=3113, p<0.0001). Mean mental-health related hospital costs per patient in the BPP group were $625 (SD $3326) compared to $283 (SD $2223) in the BPO group (p<0.0001). Overall mean medication costs were $2638 (SD $3765) in the BPP group compared to $2397 (SD$3482, p=0.003), while mean costs for outpatient visits (other than physician visits) were not significantly different (p=0.078). Overall mean health care costs were $10,263 (SD $19,962) in the BPP group compared to $8,649 (SD $15,132) in the BPO group (p<0.0001). CONCLUSIONS: Patients with bipolar I disorder with psychotic symptoms had higher health care utilization and costs compared to patients without psychotic symptoms. Research on interventions targeting bipolar patients with psychotic symptoms may be warranted.