Gralise — CareFirst (Caremark)
Fibromyalgia
Preferred products
- gabapentin immediate-release
Initial criteria
- Request is for Lyrica (pregabalin immediate-release)
- Requested drug is prescribed for one of the listed indications
- If the request is for Lyrica oral solution, patient meets one of: (a) difficulty swallowing oral solids OR (b) requires a dose unobtainable using capsules
Reauthorization criteria
- Request is for Lyrica (pregabalin immediate-release)
- Indication remains one of the listed
- If the request is for Lyrica oral solution, patient meets one of: (a) difficulty swallowing oral solids OR (b) requires a dose unobtainable using capsules
- Patient has achieved or maintained a positive clinical response
Approval duration
12 months