Lyrica (pregabalin) — CareFirst (Caremark)
Neuropathic pain associated with diabetic peripheral neuropathy
Preferred products
- gabapentin immediate-release
- duloxetine
- venlafaxine
- tricyclic antidepressant
Initial criteria
- For Lyrica (pregabalin immediate-release): patient has inadequate treatment response, intolerance, or contraindication to gabapentin immediate-release
- If Lyrica oral solution—patient has difficulty swallowing oral solids OR requires a dose not obtainable via capsules
- For Lyrica CR (pregabalin extended-release): patient has inadequate treatment response, intolerance, or contraindication to TWO of the following: gabapentin immediate-release, pregabalin immediate-release, duloxetine, venlafaxine, tricyclic antidepressant
Reauthorization criteria
- Request is for Lyrica or Lyrica CR
- If Lyrica oral solution—patient has difficulty swallowing oral solid dosage forms OR requires a dose not obtainable via capsules
- Patient has achieved or maintained a positive clinical response to the requested drug
Approval duration
12 months