Does Medicare Cover Lyrica? 

Lyrica is a brand-name drug that contains pregabalin. It is an anticonvulsant, analgesic, and anxiolytic medication that physicians often prescribe for various medical conditions. 

As of now, Lyric has been approved by the FDA to treat any of the following conditions in adults:

  • Diabetic nerve pain
  • Nerve pain caused by shingles
  • Nerve pain caused by a spinal cord injury
  • Fibromyalgia
  • Epilepsy
  • Restless leg syndrome
  • Generalized anxiety disorder 
  • Partial seizures (as an addition to other seizure medications) 

How does Medicare cover Lyrica?

If your health care provider prescribes Lyrica or a generic version of the drug pregabalin to treat a medical condition like those mentioned above, Medicare Part D insurance might help cover some of your out-of-pocket expenses. 

Since Medicare Part A and Part B do not include prescription drug coverage, Part D was created to help lower drug costs. It is optional insurance, but most people choose to enroll when they’re first eligible. If you choose to delay enrollment beyond your Initial Enrollment Period and don’t have other creditable coverage, you may have to pay late fees. 

Does Medicare cover prescriptions of Lyrica? 

To get Medicare coverage for Lyrica or the generic pregabalin, you need to have prescription drug coverage. If you are enrolled in Original Medicare, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan (PDP). If you would rather get your Medicare benefits through a Medicare Advantage (MA), you can choose from one of the many MA plans that include drug coverage. 

Many Medicare prescription drug plans cover the generic form of pregabalin, and some may also cover the brand-name drug Lyrica. You should check your plan’s formulary (list of covered drugs) to see whether the drugs are included.  

How much will Lyrica cost with Part D?

Because Medicare prescription drug plans are sold by private insurance companies, they can set their own charges like deductibles, coinsurance, and copayments. Copayment amounts are based on which tier the drugs are categorized. 

For example, tier one drugs are the most commonly prescribed generic drugs, and they carry a very low copayment. Some plans don’t charge any copayment for tier one drugs. Tier two drugs are generic brands that aren’t as commonly prescribed, and the copayment is quite low. Most Part D plans categorize generic pregabalin on this tier.  Tier three drugs are brand-name drugs and would include prescriptions like Lyrica. This tier carries a higher copayment, but not as high as tier four drugs. 

If you have Part D coverage but find that your drug costs are too high, you can explore your options during a Medicare enrollment period. Each year, Medicare’s Open Enrollment Period, from October 15 through December 7, allows Medicare recipients to make a change in their coverage. If you’re already enrolled in a Medicare Advantage plan, you also have the opportunity to participate in the Medicare Advantage Open Enrollment Period. From January 1 through March 31, you can make one change to your MA plan. 

How much does Lyrica cost without Medicare coverage? 

While your actual out-of-pocket costs depend on the strength of the dosage and where you purchase the prescription, the national average price for 90 capsules of 100 mg strength Lyrica is between $780 and $1290. For 90 capsules of 100 mg strength pregabalin (the generic version of Lyrica) you’d pay between $13 and $15 nationwide. 

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