Lyrica loses patent protection, generics now available

Lyrica is commonly used to treat pain caused by nerve damage due to diabetes, shingles (herpes zoster) infection, fibromyalgia or spinal cord injury. It is also used with other medications to treat certain types of seizures.1

New therapeutic equivalent generics (pregabalin) to Lyrica received approval from the United States Food and Drug Administration (FDA) as of July 2019 and are now in the market:

  • Lyrica brand capsules - Nine generic (pregabalin) options are currently available.
  • Lyrica brand solution (liquid formulation) - One generic option is currently available.
  • Lyrica CR is not available as a generic and is considered non-covered on Cigna formularies, and will remain off-formulary/not covered2 (non-preferred brand with prior authorization on Legacy formularies).

Coverage for Lyrica generic alternatives under Cigna-administered plans will take place as follows:3,4,5

  • Immediately - Generic pregabalin capsules and solution (when available) will process at Tier 1 without utilization management.
  • As of August 14, 2019 - Lyrica brand capsules will move from preferred brand to off-formulary/not covered2 - for Cigna formularies (non-preferred brand with prior authorization on Legacy formularies). Lyrica brand solution (liquid formulation) will remain as a preferred brand at this time, pending availability of generic stock.

Most pharmacies will replace the branded Lyrica with an available generic at the time of dispensing.

  1. Lyrica. WebMD.com. August 5, 2019. < https://www.webmd.com/drugs/2/drug-93965/lyrica-oral/details>.
  2. If a customer and/or prescriber believes any of the products that will no longer be covered as preferred options are medically necessary, then Cigna will review requests for a medical necessity exception.
  3. Medical plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. Coverage is subject to plan copayment, coinsurance or deductible requirements. Refer to your plan documents for costs and complete details of coverage.
  4. State laws in Texas and Louisiana may require your plan to cover your medication at your current benefit level until your plan renews. This means that if your medication is taken off the drug list, is moved to a higher cost-share tier or needs approval from Cigna before your plan will cover it, these changes may not begin until your plan’s renewal date. To find out if these state laws apply to your plan, please call Customer Service using the number on your Cigna ID card.
  5. State law in Illinois may require your plan to cover your medications at your current benefit level until your plan renews. This means that if you currently have approval through a review process for your plan to cover your medication, the drug list change(s) listed here may not affect you until your plan renewal date. If you don’t currently have approval through a coverage review process, you may continue to receive coverage at your current benefit level if your doctor requests it. To find out if this state law applies to your plan, please call Customer Service using the number on your Cigna ID card.

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Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. Some plans require use an in-network pharmacy for prescriptions to be covered. Coverage is subject to any plan deductible, copayment and/or coinsurance requirements. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and complete details of prescription drug coverage, contact a Cigna representative.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, (CHLIC), Cigna Behavioral Health, Inc., Cigna Health Management, Inc., Accredo Health Group, Inc., Express Scripts, Inc., ESI Mail Pharmacy Service, Inc., Express Scripts Pharmacy, Inc., Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., Lynnfield Drug, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC). The Cigna name, logo, and other Cigna marks are trademarks of Cigna Intellectual Property, Inc. "Express Scripts" is a trademark of Express Scripts Strategic Development, Inc. This newsletter is not intended for residents of New Mexico.

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