Gralise — CareFirst (Caremark)
Postherpetic neuralgia
Preferred products
- gabapentin immediate-release
Initial criteria
- Request is for one of the listed drugs
- If request is for Lyrica oral solution, patient meets one of: (a) difficulty swallowing oral solids OR (b) requires unattainable capsule dose
- Patient has experienced inadequate response, intolerance, or contraindication to gabapentin immediate-release
Reauthorization criteria
- Request is for one of the listed drugs
- If Lyrica oral solution requested, patient meets swallowing/dose requirements
- Patient has achieved or maintained a positive clinical response
Approval duration
12 months