OBJECTIVES: The purpose of this study was to model the economic impact of a prior authorization (PA) requirement for pregabalin from a US health plan perspective. METHODS: An Excel-based model was developed to simulate two hypothetical scenarios:  1) A health plan in which a PA is placed on pregabalin, and 2) a health plan in which there is no PA.  In both scenarios, a mix of brand and generic products based on secondary prescription data from IMS was assumed dispensed to patients who did not receive a pregabalin prescription or who were denied pregabalin in the PA process.  PA rejection rates were obtained from a PBM database analysis. The pregabalin prescribing rate was set to 10.3% in both the PA and no PA scenarios, with a denial rate of 50% in the PA scenario.  The model incorporated the drug wholesale acquisition cost (WAC) or the federal upper limit for generics, cost of PA administration (published literature), and copayments, in each scenario for a cohort of 1000 patients over a one-year period.  Sensitivity analyses were carried out with various PA administration costs and product mixes for the pregabalin alternatives. RESULTS: The difference in costs between the two scenarios was 0.4% ($886,000 for the PA scenario vs. $889,000 for the “no PA” scenario).  Setting the PA administration cost to zero, the difference in drug acquisition costs alone was 0.8%. When the product alternatives to pregabalin were replaced with gabapentin only, the difference in drug acquisition costs alone was 3.4%. CONCLUSIONS: Based on the actual mix of products used across pregabalin indications, a PA on pregabalin has a minimal impact on total costs to the health plan.  The difference in drug acquisition costs was less than 1% for a mix of product alternatives based on audited prescription data.