Medicare AdvantagePrior AuthMedium impact
Lyrica® CR (pregabalin) (Revised)
Humana·Endocrinology, Neurology, Pain Management +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Lyrica CR (pregabalin extended-release) for diabetic peripheral neuropathy and post-herpetic neuralgia. Patients must have failed at least two specific first-line treatments before Lyrica CR will be approved.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for Lyrica CR prescriptions for Humana Medicare Advantage patients. Ensure providers document diagnosis of diabetic peripheral neuropathy or post-herpetic neuralgia and previous trial/failure of at least two required medications (gabapentin, duloxetine, lidocaine 5% patch, or immediate-release pregabalin for DPN; gabapentin, lidocaine 5% patch, or immediate-release pregabalin for PHN). Submit prior authorization requests through www.humana.com/PAL before prescribing.