Gralise (gabapentin extended-release) — CareFirst (Caremark)

Preferred products

• gabapentin immediate-release

Initial criteria

• The request is for one of the listed drugs.
• If the request is for Lyrica oral solution, the patient has difficulty swallowing oral solid dosage forms OR requires a dose that cannot be obtained using the commercially available capsules.
• The patient experienced an inadequate treatment response, intolerance, or has a contraindication to gabapentin immediate-release.

Reauthorization criteria

• The request is for one of the listed drugs.
• If the request is for Lyrica oral solution, the patient has difficulty swallowing oral solid dosage forms OR requires a dose that cannot be obtained using the commercially available capsules.
• The patient has achieved or maintained a positive clinical response to the requested drug.

Approval duration

12 months