Further Savings for All Pregabalin (Lyrica®) Strengths

Pregabalin (Lyrica®) is an important pharmacologic agent in the drug armamentarium as a non-opioid adjunctive agent providing an opioid-sparing effect. Pregabalin has been in the top 10 prescribed drugs in the workers’ compensation realm and has recently seen a further decline in price.

Pregabalin is an anti-epileptic/anticonvulsant drug which is FDA-indicated for neuropathic pain related to diabetic peripheral neuropathy and spinal cord injury, fibromyalgia, postherpetic neuralgia, and as an adjunct for partial seizures. For patients with chronic neuropathic (nerve) pain, initial first-line treatments include tri-cyclic antidepressant (TCA) or serotonin norepinephrine reuptake inhibitor (SNRI) anti-depressants or an anti-epileptic drug (AED) such as gabapentin or pregabalin.

Please refer to the table below outlining a significant difference in the lowest average wholesale price (AWP) between the previous and current AWP, per CMS’ recognized and approved compendium, Red Book. Updates to the MSA will significantly mitigate Part D allocation and save Workers’ Compensation payers money, facilitate settlement and allow for closure of claims.

Table 1: Current Pricing Spectrum and Savings

Pregabalin strength/formulation

Previous lowest AWP

Current lowest AWP

~% Savings

25mg capsule

$1.58

$0.02

99%

50mg capsule

$0.90

$0.04

96%

75mg capsule

$0.92

$0.04

96%

100mg capsule

$1.00

$0.05

95%

150mg capsule

$1.14

$0.06

95%

200mg capsule

$1.99

$0.07

96%

225mg capsule

$2.55

$0.08

97%

300mg capsule

$2.05

$0.09

96%

 

ExamWorks Clinical Solutions’ Doctors of Pharmacy offer risk evaluation mitigation, alternatives to high cost Medicare-covered medications, and clarification of drug regimens to provide the most accurate and defensible MSA. The goal of the program is to impact medication therapy and mitigate MSA drug costs by consulting with the treating provider on the clinical rationale. ExamWorks utilizes technology and compendia databases which are recognized and supported by the CMS to support inclusion or exclusion of a drug under the Part D benefit. We will continue to monitor changes in medication pricing as well as availability of generic equivalents within the marketplace. 

For questions about medications or the ExamWorks Clinical Solutions Pharmacy programs, please contact Nahla D. Rizkallah, PharmD at 678.256.5086 or nahla.rizkallah@examworks-cs.com

Nahla Rizkallah, PharmD, MSCC

Nahla Rizkallah, PharmD, MSCC

Nahla D. Rizkallah, PharmD, MSCC, serves as the Senior Clinical Pharmacist at ExamWorks Compliance Solutions. In this capacity, she performs prescription analysis to optimize drug therapy using evidence-based guidelines and national guidelines, and participates in physician outreaches to implement the recommendations. She has 29 years of experience in various area of pharmacy practice including: review of Part D medications on Medicare Set-Aside Allocations, prior authorization reviews for the Florida Medicaid program as Senior Clinical Pharmacist, development of drug utilization criteria, academic detailing, Pharmacy and Therapeutics Committee, Pharmacy Manager for a closed mental health facility, Pharmacy Manager for the indigent, staff/clinical pharmacist for assisted- living facilities (ALFs), medication audits for ALFs, drug information center, clinical pathways, staff education, and surgical/medical pharmacy satellite at All Children’s Hospital. Dr. Rizkallah has the following certifications: Medicare Set-Aside Certified Consultant, Hypertension and Dyslipidemias, and Diabetes. Dr. Rizkallah received her Doctorate from the University of Florida in Gainesville followed by a one year American Society of Health-System Pharmacists accredited residency.

For questions about medications or the ExamWorks Compliance Solutions Pharmacy programs, please contact Nahla D. Rizkallah, PharmD at 678.256.5086 or nahla.rizkallah@examworkscompliance.com

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