UnitedHealthcare
Lyrica (pregabalin)
Drugs for the Nervous System : Drugs for Seizures /Personality Disorder/Nerve Pain
  • Quantity Limit: limit maximum 3 EA PER 1 day(s)
  • Prior Authorization: Diabetic Peripheral Neuropathy:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Post-herpetic Neuralgia:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)

  • Step Therapy: Post-herpetic Neuralgia:
    ST Single Generic

  • Diabetic Peripheral Neuropathy:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Post-herpetic Neuralgia:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A