Lyrica® Medicare Coverage

Lyrica®
Chemical name: Pregabalin

Typical dosage: 150mg

Typical type: Capsule1

Lyrica® is a medication commonly used for nerve pain, certain types of seizures, and fibromyalgia. Lyrica is available as brand only, and comes in an oral capsule, oral solution and extended-release tablet taken by mouth.

Lyrica is a schedule V prescription medication that contains the active ingredient Pregabalin.

It is typically taken 1-3 times daily, depending whether you are taking it for nerve pain, seizures or fibromyalgia. Lyrica works by modifying nerve signals that are associated with seizures and pain.

Common side effects of Lyrica include dizziness, drowsiness, dry mouth, constipation, swelling, blurred vision and weight gain.

Does Medicare cover Lyrica?

Yes! 100% of Medicare Advantage plans and Medicare Part D plans cover Lyrica.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Lyrica.

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Average costs for Lyrica with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$42 – $551 $19 – $543

Additional information

Lyrica is a schedule V medication due to its low potential for abuse. While many patients can safely use Lyrica, information is limited in pregnancy, and it could pose a risk to the developing fetus. Breastfeeding is not recommended during Lyrica therapy.

Use with caution if you have heart failure, kidney abnormalities or a history of substance abuse.

Swelling from the use of Lyrica can become life threatening. Symptoms include facial, mouth, and neck swelling. If you have a history of edema, use caution when taking this drug and talk to your doctor immediately if you experience swelling.

Lyrica may increase the risk of suicidal thoughts and behavior as early as 1 week after starting the medication. Talk to your doctor if you have signs of depression, nervousness, restlessness, panic attacks or negative changes in mood or actions.

If you are taking Lyrica, do not stop the medication without advice from a doctor. You should avoid drinking alcohol while using Lyrica because it may increase the sedative effects of the drug.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Lyrica. Retrieved May 2019, from www.goodrx.com/lyrica.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.