Does Medicare cover Lyrica?
Pregabalin is covered by Medicare Part D and Medicare Advantage (Part C) plans. Some plans may also cover the brand Lyrica, but you may have to pay the difference in cost between the generic and brand-name price. This is because the brand cost is typically higher, and plans tend to cover generics when they are available.
If youâ€™re eligible for original Medicare, (Part A and Part B), you can choose to enroll in Part D and Part C plans.
These plans are offered by private insurance companies that contract with Medicare. You can choose from various plan options based on your budget, location, and coverage needs.
Part C plans often include prescription drug coverage along with many other healthcare benefits, while Part D plans only offer prescription drug benefits.
Every plan comes with different deductibles, coinsurance, and copay costs. Both types of plans may have restrictions on using specific doctors and/or pharmacies within its network for maximum cost savings.
You can contact your plan provider directly to ask how much Lyrica might cost you. You can also compare different Medicare plans, costs, and coverage based on where you live by using Medicareâ€™s plan finder tool.
Enter â€œLyricaâ€ under your prescriptions to see the average cost where you live.
How much does Lyrica cost?
The cost of Lyrica depends on what type of Medicare plan you have (Part D or Part C) and your individual planâ€™s coverage rules. All Part D plans have formularies, or lists of covered medications, based on Medicare guidelines.
Plan formularies have several tiers based on the cost of the medications (generic, brand, or specialty). Generic pregabalin is on tier 1, or the lowest cost for most plans. You may have to pay a higher cost if you want Lyrica.
Lyrica ranges in price between $8 to $565, depending on deductibles and copays for the specific plan. In comparison, the average price for generic pregabalin is either $0 or just a few dollars.
Some plans will only cover the generic. You can check with your plan for specific coverage questions and costs.
Medicare plans may also have a limit on the number of daysâ€™ supply you can get for Lyrica. This might also cost you more in deductibles and copays, since you tend to pay less when you fill a large supply of a medication at one time.
How can I get more help to cover my prescription drug costs?
You may be able to save money on the cost of Lyrica, or the generic, if you qualify for certain Medicare savings programs, Medicaid, or other medication assistance or rebate programs. However, since brand-name Lyrica is more expensive, it would not likely be covered by any income-based savings programs because a generic is available.
Here are a few options to look into if you find you need help paying for your medications.
The Medicare low-income subsidy, or Extra Help program, helps pay for prescription medication premiums and copays. You must meet certain income and financial need thresholds to qualify for this program.
State Health Insurance Assistance Programs (SHIP) can help answer questions about Medicare plans. They can also help you find financial assistance for prescription medications or other healthcare costs based in your local area.
The Medicaid program may pay all or most of the cost for certain medications after Medicare pays its share. Check with your state Medicaid office to see if you qualify.
Medicare savings programs
There are four Medicare savings programs that are run by state Medicaid offices. These programs help pay for certain Medicare costs, such as premiums, deductibles, coinsurance, and copays. They also cover prescription medications if you meet certain income and other financial qualifications.
The Programs of All-Inclusive Care for the Elderly (PACE) can also help with Part Dâ€“covered prescription medications, like pregabalin, if you qualify. You donâ€™t need to have a separate Part D plan if you qualify for the PACE program.
Pricing sites and rebates
To compare pricing and costs of Lyrica, you can search pharmacy discount sites like GoodRx.com. This will let you see prices for brand-name and generic forms of Lyrica from different pharmacies.
If you want the brand name Lyrica, you can also contact the manufacturer and ask about any rebates or discount programs. The PfizerRxPathways program can provide information about savings programs if you qualify.
What is Lyrica?
Lyrica is a prescription medication for treating several types of nerve pain, including:
- diabetic peripheral neuropathy
- postherpetic neuralgia
- nerve pain from a spinal injury
- fibromyalgia pain
It may also be prescribed for partial onset seizures.
Pregabalin, the generic version of Lyrica, was approved in 2019 and has made the medication much more affordable, even without prescription drug coverage.
Although the exact way Lyrica works is not definitively known, scientists believes it calms overactive or damaged nerves that can lead to seizures or pain.
Lyrica is a U.S. Drug Enforcement Administration (DEA) Schedule V category controlled substance due to its potential for misuse. However, it is not an opioid medication.
Potential side effects and other considerations
Two of the most commonly reported side effects of Lyrica are dizziness and sleepiness. Until you know how this medication will affect you, be careful driving, operating machinery, or doing any tasks that require alertness.
Other side effects of Lyrica may include:
- blurry vision
- dry mouth
- weight gain
- difficulty concentrating
- swelling of hands and feet
Let your doctor know if you have a history of heart-related problems, trouble breathing, allergic reactions to medications, substance misuse, depression, or mood-related issues. Taking Lyrica might affect these conditions. Your doctor will discuss the risks versus the benefits of Lyrica with you before prescribing the medication.
Itâ€™s also recommended to avoid alcohol or opioid medications while taking Lyrica. These can have additive side effects like drowsiness, sleepiness, and dizziness, which could be dangerous.
Your doctor may prescribe a lower dose of Lyrica if you have a kidney condition, because the medication may build up in your body and potentially cause more harm to your kidneys.
Although Lyrica is not an opioid medication, suddenly stopping the medication can cause withdrawal symptoms in some people.
Symptoms of withdrawal include:
Lyrica may also cause suicidal thoughts or behavior. Call 911 immediately if you experience changes in your mood, worsening depression, or thoughts of harming yourself.
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