Lemtrada® (alemtuzumab)

Lemtrada (alemtuzumab) is covered only for adults ≥17 with relapsing forms of MS (relapsing‑remitting or active secondary‑progressive) when prescribed by or in consultation with an MS specialist; non‑FDA indications and patients <17 are not covered. Initial approval requires failure/intolerance to two DMTs OR prior receipt of specified high‑efficacy agents (Kesimpta, Tysabri, Tyruko, Briumvi, Mavenclad, Ocrevus) OR documentation of highly active/aggressive MS; reauthorization requires completion of the initial 5‑dose course, ≥12 months since the last Lemtrada dose, objective evidence of clinical benefit or stabilization, and dosing must follow 12 mg/day IV (initial 5 consecutive days; subsequent courses 3 consecutive days ≥12 months apart).

"Age restriction: patient must be 17 years of age or older (policy explicitly requires ≥17)."

Sign up to see full coverage criteria, indications, and limitations.