pregabalin 100 MG Oral Capsule [Lyrica]
pregabalin
RxCUI: 607018
What the CMS Formulary Data Shows for pregabalin 100 MG Oral Capsule [Lyrica]
Per the CMS 2026 Part D formulary file, pregabalin 100 MG Oral Capsule [Lyrica] (RxNorm concept RXCUI 607018, generic name pregabalin) appears on 1 distinct formulary file spanning 2 Medicare Part D plan offerings - 0% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 1, with a cross-plan average of Tier 1.
Real-world access to pregabalin 100 MG Oral Capsule [Lyrica] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,328,626 Part D beneficiaries filled pregabalin 100 MG Oral Capsule [Lyrica] in 2023, with total plan-and-beneficiary spending of $287,950,539 and an average per-beneficiary annual cost of $216.73. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry pregabalin 100 MG Oral Capsule [Lyrica] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 2
- Coverage rate
- 0%
- Tier range
- Tier 1, Preferred Generic
- Average tier
- Tier 1, Preferred Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,328,626
- Total spending
- $287,950,539
- Avg per beneficiary
- $216.73
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering pregabalin 100 MG Oral Capsule [Lyrica]
2 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
Frequently Asked Questions
Is pregabalin 100 MG Oral Capsule [Lyrica] covered by Medicare Part D?
Yes, pregabalin 100 MG Oral Capsule [Lyrica] is covered by 2 Medicare Part D plans (0% of all Part D formularies).
What tier is pregabalin 100 MG Oral Capsule [Lyrica] on Medicare Part D plans?
pregabalin 100 MG Oral Capsule [Lyrica] averages Tier 1 across Part D plans, ranging from Tier 1 to Tier 1.
Does pregabalin 100 MG Oral Capsule [Lyrica] require prior authorization?
0% of Part D formularies require prior authorization for pregabalin 100 MG Oral Capsule [Lyrica]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on pregabalin 100 MG Oral Capsule [Lyrica]?
In 2023, total Medicare Part D spending on pregabalin 100 MG Oral Capsule [Lyrica] was $287,950,539, covering 1,328,626 beneficiaries. The average spend per beneficiary was $216.73.
Read our methodology - how this data is sourced, computed, and verified.