Does Priority Health Cover Lyrica

Explore Priority Health's Lyrica coverage policies, reasons for denial, tips to secure coverage, cost insights without insurance, and an FAQ section.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Does Priority Health Cover Lyrica?

 

  • Lyrica (pregabalin) is often used to treat nerve pain, fibromyalgia, and seizures. Coverage depends on your specific Priority Health benefits plan.
  •  

  • Typically, prior authorization may be required, meaning your doctor must verify that Lyrica is medically necessary for you.
  •  

  • Your plan might require trying certain other medications first (step therapy) before approving Lyrica.
  •  

  • Check for any associated costs such as copays or if Lyrica falls under tiered pricing, which could affect your out-of-pocket expense.

 

Basic Rules and Criteria

 

  • Must have a doctor’s prescription indicating why Lyrica is needed based on your health condition.
  •  

  • Coverage may vary between different Priority Health plans, so reviewing your specific policy details is essential.
  •  

  • Contacting Priority Health customer service can provide personalized information about Lyrica coverage and any documentation needed for approval.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Lyrica Coverage with Priority Health

 

Choose the Right Plan

 

  • Check Priority Health's website to review their various health insurance plans that include prescription drug coverage.
  • Consult the drug formulary for each plan to ensure Lyrica (pregabalin) is covered. This is a list of covered medications which can often be found in the plan details.
  • If you are unsure, contact Priority Health's customer service for confirmation on Lyrica's coverage within different plan options.

 

Enroll in a Suitable Plan

 

  • If you are not yet a Priority Health member, you can enroll in a suitable plan on their website, through healthcare marketplaces, or via an insurance broker.
  • If you're a current member, you may need to wait for the open enrollment period to switch plans if your current one does not cover Lyrica.
  • Ensure that the plan you choose fits both your health needs and budget constraints while offering Lyrica coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your need for Lyrica and ensure it is the most suitable medication for your condition.
  • Your healthcare provider may need to document the medical necessity for Lyrica, which may be required by Priority Health for coverage approval.
  • Request your provider supply any necessary prior authorization forms or additional documentation that Priority Health may require.

 

Submit Required Paperwork

 

  • Gather all required documents, such as a prescription from your healthcare provider, prior authorization forms, and any other documents specified by Priority Health.
  • Submit the paperwork through the claims or healthcare provider portal available on Priority Health’s website, or send it via fax/mail as instructed by them.
  • Ensure all forms are correctly filled out to avoid delays in processing your coverage request.

 

Follow Up with Priority Health

 

  • After submission, regularly check the status of your coverage request by visiting your Priority Health member portal or contacting their customer service.
  • If your request is denied, seek clarification on the reasons and inquire about necessary steps for appeal. You may need to provide additional documentation or explore alternative options.
  • Once approved, verify the Lyrica cost under your plan to understand your out-of-pocket expenses like copays or deductibles.

 

Utilize the Coverage

 

  • Once your coverage for Lyrica is approved, take your prescription to an in-network pharmacy to fill it, which can help minimize additional costs.
  • Ensure ongoing compliance with any plan requirements, such as getting timely refills and attending regular check-ups, to maintain your coverage.
  • Stay informed of any changes to your Priority Health plan that might affect Lyrica coverage, especially during plan renewals.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Priority Health Cover Lyrica

Explore Priority Health's Lyrica coverage policies, reasons for denial, tips to secure coverage, cost insights without insurance, and an FAQ section.
Curex allergy drops unboxing

Is Lyrica Covered by Priority Health

 

Does Priority Health Cover Lyrica?

 

  • Lyrica (pregabalin) is often used to treat nerve pain, fibromyalgia, and seizures. Coverage depends on your specific Priority Health benefits plan.
  •  

  • Typically, prior authorization may be required, meaning your doctor must verify that Lyrica is medically necessary for you.
  •  

  • Your plan might require trying certain other medications first (step therapy) before approving Lyrica.
  •  

  • Check for any associated costs such as copays or if Lyrica falls under tiered pricing, which could affect your out-of-pocket expense.

 

Basic Rules and Criteria

 

  • Must have a doctor’s prescription indicating why Lyrica is needed based on your health condition.
  •  

  • Coverage may vary between different Priority Health plans, so reviewing your specific policy details is essential.
  •  

  • Contacting Priority Health customer service can provide personalized information about Lyrica coverage and any documentation needed for approval.

A weight management program tailored to you

Start with Curex

Priority Health's Approved Criteria for Lyrica Coverage

 

Criteria for Coverage of Lyrica

 

  • Lyrica is approved for the management of neuropathic pain associated with diabetic peripheral neuropathy. Patients must demonstrate a clinical need for treatment as documented by healthcare providers.
  •  

  • The medication is covered for the treatment of postherpetic neuralgia, where other therapeutic options have been ineffective or are contraindicated.
  •  

  • Coverage is available for fibromyalgia, provided that there is documented evidence of a diagnosis, and first-line therapies have resulted in inadequate relief or are unsuitable for the patient.
  •  

  • Priority Health approves Lyrica for the management of neuropathic pain associated with spinal cord injury, contingent on substantiated need due to symptomatology unresponsive to conventional pain management strategies.
  •  

  • Treatment for partial onset seizures in adults with epilepsy may be covered if the medication is used adjunctively with other antiepileptic drugs when previous treatment regimens have not adequately controlled seizure activity.
  •  

  • Lyrica may be covered under conditions wherein it is medically necessary based on the specific circumstances and patient history, as evaluated by a clinical reviewer.

 

Why Priority Health Might Deny Lyrica Coverage

 

Situations Where Coverage is Denied

 

  • **Off-Label Use:** Lyrica prescribed for conditions not approved by the FDA or not supported by Priority Health's formulary guidelines may be denied coverage.
  •  

  • **Lack of Prior Authorization:** If there is a failure to obtain prior authorization from Priority Health before prescribing Lyrica, coverage is likely to be denied.
  •  

  • **Non-Formulary Drug:** Lyrica may not be covered if it is not included on Priority Health's formulary list, or if there are preferred alternatives available.
  •  

  • **Inadequate Documentation:** Lacking proper medical records, documentation, and detailed justification for the necessity of Lyrica can result in denial.
  •  

  • **Age Restrictions:** Prescriptions for patient age groups that are outside of the approved range for Lyrica may not be covered.
  •  

  • **Duplicate Therapy:** If Lyrica is prescribed along with another medication containing the same active ingredient without sufficient justification, it might be denied.
  •  

  • **Non-Adherence to Step Therapy Protocols:** Failure to follow step therapy protocols, such as trying other medications before Lyrica, could lead to a denial of coverage.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Lyrica Cost without Insurance?

 

Cost of Lyrica Without Insurance

 

  • The price of Lyrica without insurance can vary significantly depending on the pharmacy, geographic location, dosage, and quantity. On average, the cost can range between $460 to $720 for a 30-day supply when filling a common dosage such as 150 mg capsules.
  •  

  • Generic versions of Lyrica, known as pregabalin, are often significantly cheaper. The average cost for the generic version might be closer to $30 to $70 for a similar quantity and dosage.
  •  

  • Prices may also vary due to manufacturer's discounts, pharmacy membership programs, or coupon usage, which can help reduce the overall cost.
  •  

  • Comparing prices between local pharmacies or using online price comparison tools can help find the most affordable option.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Lyrica Coverage with Priority Health

 

Choose the Right Plan

 

  • Check Priority Health's website to review their various health insurance plans that include prescription drug coverage.
  • Consult the drug formulary for each plan to ensure Lyrica (pregabalin) is covered. This is a list of covered medications which can often be found in the plan details.
  • If you are unsure, contact Priority Health's customer service for confirmation on Lyrica's coverage within different plan options.

 

Enroll in a Suitable Plan

 

  • If you are not yet a Priority Health member, you can enroll in a suitable plan on their website, through healthcare marketplaces, or via an insurance broker.
  • If you're a current member, you may need to wait for the open enrollment period to switch plans if your current one does not cover Lyrica.
  • Ensure that the plan you choose fits both your health needs and budget constraints while offering Lyrica coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your need for Lyrica and ensure it is the most suitable medication for your condition.
  • Your healthcare provider may need to document the medical necessity for Lyrica, which may be required by Priority Health for coverage approval.
  • Request your provider supply any necessary prior authorization forms or additional documentation that Priority Health may require.

 

Submit Required Paperwork

 

  • Gather all required documents, such as a prescription from your healthcare provider, prior authorization forms, and any other documents specified by Priority Health.
  • Submit the paperwork through the claims or healthcare provider portal available on Priority Health’s website, or send it via fax/mail as instructed by them.
  • Ensure all forms are correctly filled out to avoid delays in processing your coverage request.

 

Follow Up with Priority Health

 

  • After submission, regularly check the status of your coverage request by visiting your Priority Health member portal or contacting their customer service.
  • If your request is denied, seek clarification on the reasons and inquire about necessary steps for appeal. You may need to provide additional documentation or explore alternative options.
  • Once approved, verify the Lyrica cost under your plan to understand your out-of-pocket expenses like copays or deductibles.

 

Utilize the Coverage

 

  • Once your coverage for Lyrica is approved, take your prescription to an in-network pharmacy to fill it, which can help minimize additional costs.
  • Ensure ongoing compliance with any plan requirements, such as getting timely refills and attending regular check-ups, to maintain your coverage.
  • Stay informed of any changes to your Priority Health plan that might affect Lyrica coverage, especially during plan renewals.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Lyrica FAQ

What are the common side effects of Lyrica?

 

Common Side Effects of Lyrica

 

  • Dizziness: Frequently reported, often occurring shortly after starting treatment.
  • Sleepiness: Commonly affects daily activities due to its sedative effects.
  • Weight Gain: Notable for some, monitoring weight is advised.
  • Swelling: Particularly in hands and feet; may require medical attention if severe.
  • Blurred Vision: Usually temporary but should be reported if persistent.
  • Dry Mouth: Sometimes improved with increased fluid intake.
  • Difficulty concentrating: Can affect mental clarity and focus.

 

Is Lyrica the same as gabapentin?

 

Differences Between Lyrica and Gabapentin

 

  • Classification: Both are anticonvulsants but with different active ingredients. Lyrica contains pregabalin, while gabapentin itself is the active substance in gabapentin medications.
  •  

  • FDA Approval: Lyrica is approved for treating fibromyalgia, neuropathic pain, seizures, and generalized anxiety disorder in certain regions. Gabapentin's primary uses are for seizures and nerve pain.
  •  

  • Potency and Dosing: Lyrica is often considered more potent, requiring lower doses to achieve similar effects compared to gabapentin.
  •  

  • Side Effects: Both can cause dizziness and fatigue, but the severity and other side effects can vary between individuals.

 

Can Lyrica help with anxiety?

 

Understanding Lyrica and Anxiety

 

  • Lyrica (pregabalin) is primarily approved for treating nerve pain, fibromyalgia, and seizures.
  •  

  • Although not FDA-approved for anxiety, it has been used off-label to help some patients manage anxiety symptoms, especially in generalized anxiety disorder (GAD).

 

Mechanism and Effectiveness

 

  • Lyrica works by calming hyper-excited nerves, which may reduce anxiety symptoms by stabilizing neuronal activity.
  •  

  • Clinical studies suggest it can reduce anxiety more effectively than a placebo and comparable to some anxiety medications.

 

Considerations and Side Effects

 

  • Possible side effects include dizziness, sleepiness, and weight gain, which should be considered before off-label use.
  •  

  • Consult your doctor to assess if Lyrica aligns with your specific health needs and to discuss alternate anxiety treatments.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Made in Webflow