Alemtuzumab (Lemtrada)
EVICORE-MEDICAL_DRUG-1C844E06
Alemtuzumab (Lemtrada) is covered for FDA‑approved relapsing forms of multiple sclerosis in patients ≥17 years who meet safety criteria; it is contraindicated with HIV infection and cannot be used with another MS disease‑modifying agent. Key requirements include prior inadequate response to ≥2 MS drugs for initial approval, enrollment in the Lemtrada REMS, pre‑medication with high‑dose corticosteroids and herpetic antiviral prophylaxis, avoidance of live vaccines, extensive baseline and periodic monitoring (CBC/differential, serum creatinine, urinalysis, thyroid tests q3 months, annual skin exams) for 48 months after last dose, and reauthorization limits (≥12 months since first course and <2 total Lemtrada courses).
"Relapsing forms of multiple sclerosis"
Sign up to see full coverage criteria, indications, and limitations.