Does Medicare Cover Lyrica?

In this article...
  • Lyrica is a popular medication used to treat nerve and muscle pain. Medicare may or may not cover Lyrica, though it does cover pregabalin, the generic version.

Lyrica, or pregabalin, is a popular medication used to treat nerve and muscle pain, including pain associated with fibromyalgia. It’s also sometimes used to treat seizures. While Medicare Advantage and Medicare Part D may not cover the name brand medication Lyrica, they do cover pregabalin, the generic version.

Some plans may also cover Lyrica, though you may need to pay the difference in cost. Cost for name brand medications are usually higher, and most Medicare plans usually only cover generic brands if they’re available.

If you’re enrolled in Original Medicare, or Part A and Part B, you can opt to enroll in Medicare Advantage and Part D plans. These are plans offered by private insurers that contract with Medicare. Medicare Advantage, also called Part C, offers plans that replace A and B and often include prescription drug coverage and other healthcare benefits, while Part D plans only cover prescription drugs.

If you’re enrolled in a Part C or Part D plan, you can contact your provider directly to find out how much Lyrica will cost you. You can also use Medicare’s plan finder tool to compare different plan costs and coverage.

Is Gabapentin Covered by Medicare?

Gabapentin is the generic form of the name-brand drug Neurontin. It’s used to treat peripheral neuropathy and other related nerve conditions. Since it’s available at retail pharmacies, and it’s considered a necessary drug for the treatment of serious health conditions, it’s usually covered under Medicare Part D.

Coverage for gabapentin may vary according to the treatment. For example, if someone is staying in a nursing facility or admitted to a hospital temporarily, and the drug is provided as part of a treatment plan, it’s usually covered by Medicare Part A. Medicare Part B benefits would cover outpatient treatment of the drug, though it’s unlikely you would receive gabapentin in this particular instance.

What Prescriptions Does Medicare Cover?

The prescriptions covered by Medicare depend on the exact treatment and the plan. Medicare Part A, for example, typically only covers drugs administered as treatment while in a hospital or nursing facility.

Part B, on the other hand, covers drugs provided by a doctor’s service and aren’t self-administered. The coverage is typically limited to drugs provided by injection or infusion. Part B also covers drugs such as:

  • Vaccinations shots, such as a flu shot or Hepatitis B shot
  • Immunosuppressant drugs
  • Osteoporosis drugs

Medicare Part D provides extensive coverage for many generic drugs and some brand-name drugs through private plans. Part D also covers most vaccinations that aren’t covered under Part B.

Generally, all Medicare Part D plans cover at least two drugs in each category of drugs. In six of these categories, however, plans are required to cover all drugs. The categories include:

  • Antipsychotics
  • Antidepressants
  • Antiretrovirals
  • Anticonvulsants
  • Immunosuppressants
  • Antineoplastics

What is the Best Prescription Drug Plan for Medicare?

The best Medicare prescription drug plan is the one that covers all your drugs for the lowest out-of-pocket costs while meeting your needs and providing good service. You can choose your plan in a couple of different ways.

You can use Medicare’s online plan finder to search for the name of each drug you’re currently prescribed. The tool allows you to enter your zip code and shows you the best plan based on drug costs in your area. You can also use the tool to:

  • See which plans have restrictions on your drugs
  • Find out which plans offer preferred pharmacies with lower copays
  • Get information on how much your drugs will cost under each plan
  • See how Medicare rates each plan based on service quality

You can also call Medicare’s 24-hour helpline at 800-633-4227, where a representative can provide you with the same information. You can also request for the results to be mailed to you. If you’re opting to call rather than use the website, be sure to make a complete list of all the drugs you take, including the dosages and how often you take them.

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