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
Previous lowest AWP
Current lowest AWP
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 firstname.lastname@example.org