Diagnosis: Chronic pelvic pain
Treatment: Lyrica
The proposed treatment, Lyrica capsules, is not medically necessary.
The patient had a history of chronic pelvic pain and had failed a number of modalities. The patient had not failed the formulary alternative, Cymbalta. Lyrica is not Food and Drug Administration (FDA) approved for chronic pelvic pain, although it has been used for numerous chronic pain conditions, and may be a reasonable alternative if formulary alternatives have first been failed. This is not a continuation of therapy, as the patient has only taken samples. Given the above, the requested Lyrica is not medically necessary.