What Lyrica is used for
Lyrica is a capsule (also an oral solution, and Lyrica CR extended-release tablets). Its FDA label covers nerve pain from diabetic peripheral neuropathy, nerve pain after shingles (postherpetic neuralgia), nerve pain from spinal cord injury, fibromyalgia, and add-on treatment of partial-onset seizures.
This page explains Medicare coverage only. Questions about whether Lyrica is right for you belong with your prescriber.
Which part of Medicare covers Lyrica
Lyrica is taken by mouth at home, so it's a Part D drug. Pregabalin is also an anticonvulsant, one of Part D's six protected classes, where plans must cover all or substantially all drugs in the class.
Is Lyrica on Medicare's negotiated-price list?
Lyrica is not among the drugs CMS has selected for the Medicare Drug Price Negotiation Program so far (the 10 drugs with negotiated prices for 2026, the 15 for 2027 and the 15 selected in January 2026 for 2028).
Generics and biosimilars
FDA approved the first generic versions of pregabalin capsules in July 2019. A plan may cover generic pregabalin and require an exception for brand-name Lyrica or Lyrica CR. Extra Help copays are lower for generics.
Refills for a controlled substance
Because pregabalin is a Schedule V controlled substance, plans and pharmacies follow stricter rules: they may set quantity limits per fill, may refuse to fill early, and may review it alongside other medications that cause drowsiness, such as opioids, as part of Medicare's drug safety programs. If you'll be traveling or need an early refill for a reason like a lost bottle, call the plan before you run out. During a declared emergency in Oregon, pharmacists may give emergency refills, but controlled substances have extra limits under OAR 855-007-0090.
What you pay for Lyrica in 2027: the out-of-pocket cap
Your cost for Lyrica depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:
- 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
- The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
- Only covered drugs count. If your plan doesn't cover Lyrica and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.
Spreading the cost: the Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when costs are high early in the year. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?
Extra Help with Lyrica
Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have OHP (Medicaid), a Medicare Savings Program or SSI; otherwise apply through Social Security at 1-800-772-1213 or ssa.gov/extrahelp. See Extra Help in Oregon.
Getting Lyrica covered in Oregon
Oregon and Washington share Part D region 30, so standalone Part D plans are offered region-wide. For 2027, Oregon has 8 standalone Part D plans from 4 companies, plus Medicare Advantage plans with drug coverage in most counties (61 open to everyone statewide). Each plan has its own formulary, so one plan's coverage of Lyrica tells you nothing about another's.
Where you live in Oregon changes your choices. CMS data show no Medicare Advantage plan open to everyone in Grant, Harney, Lake, Umatilla or Union counties for 2027 (only employer group plans), and only a special needs plan in Curry County. If you live there, coverage for Lyrica usually comes from a standalone Part D plan alongside Original Medicare, unless you have employer or other drug coverage. Check your county's numbers on Oregon counties.
If you have both Medicare and OHP, OHP doesn't pay for drugs that Part D covers. The Oregon Health Authority calls this "OHP with Limited Drug": you need a Part D plan (or a Medicare Advantage plan with drug coverage) for Lyrica, and you qualify for Extra Help automatically. See OHP and Medicare.
How to check whether a plan covers Lyrica
- Write down the exact drug. Name, strength and how often you take it. A plan can cover one form of Lyrica and not another.
- Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Lyrica and any rules.
- Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
- Check your 2027 notice. Your plan's Annual Notice of Change says whether Lyrica stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
- Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.
If your plan doesn't cover Lyrica, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in Oregon?
Sources
- National Library of Medicine — DailyMed: Lyrica prescribing information (FDA label)
- Medicare.gov — Drug coverage (Part D)
- FDA — Orange Book: approved drug products and generic equivalents
- eCFR — 42 CFR 423.120 (formularies, protected classes and transition fills)
- Oregon Board of Pharmacy — OAR 855-007-0090, emergency pharmacy rules
- CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold and Extra Help copays)
- Medicare.gov — Medicare Prescription Payment Plan
- Social Security — Extra Help with Medicare prescription drug plan costs
- CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
- CMS — Part D plan files record layout (PDP Region 30: Oregon, Washington)
- Oregon Health Authority — OHP and Medicare
Frequently asked questions
Does Medicare cover generic pregabalin?
Yes, when it's on your Part D plan's formulary. FDA approved generic pregabalin in 2019, and plans may prefer it over brand-name Lyrica.
Why won't my pharmacy refill Lyrica early?
Pregabalin is a Schedule V controlled substance, so plans and pharmacies apply stricter refill timing and quantity limits. Call your plan if you need an exception.
Does the 2027 Part D out-of-pocket cap apply to Lyrica?
Yes, when your Part D plan covers Lyrica. In 2027, once you've paid $2,400 for covered Part D drugs, you pay nothing more for covered Part D drugs for the rest of the year.
What if my plan doesn't cover Lyrica?
Ask the plan for a coverage determination or formulary exception, with a supporting statement from your prescriber, or compare plans during Open Enrollment, October 15 to December 7. New members can usually get a transition fill while they ask.
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