Edaravone Injection (Radicava)

Edaravone (Radicava) is covered only for the FDA‑approved indication of ALS in adults and excludes off‑label uses and patients under 18. Coverage requires documentation of El Escorial diagnostic criteria, %FVC ≥80%, all ALSFRS‑R item scores ≥2, disease duration ≤2 years for initial approval, reauthorization every 12 months with documented clinical benefit (approval duration 12 months).

"Treatment of amyotrophic lateral sclerosis (ALS) (FDA-approved indication)."

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