Lyrica — CareFirst (Caremark)
Neuropathic pain associated with diabetic peripheral neuropathy
Preferred products
- gabapentin immediate-release
- duloxetine
- venlafaxine
- tricyclic antidepressant
Initial criteria
- For Lyrica (pregabalin IR): if oral solution requested, patient meets one of: (a) difficulty swallowing solids OR (b) requires unattainable dose by capsule
- Patient had inadequate response, intolerance, or contraindication to gabapentin immediate-release
- For Lyrica CR (pregabalin ER): patient had inadequate response, intolerance, or contraindication to two of the following: gabapentin immediate-release, pregabalin immediate-release, duloxetine, venlafaxine, or a tricyclic antidepressant
Reauthorization criteria
- Request is for Lyrica or Lyrica CR
- If oral solution requested, patient meets swallowing/dose requirements
- Patient has achieved or maintained a positive clinical response
Approval duration
12 months