Edaravone Injection (Radicava)

Radicava (edaravone) is covered only for FDA‑approved treatment of ALS meeting the El Escorial revised diagnostic criteria and is not covered for any off‑label uses. Coverage requires age ≥18, percent‑predicted FVC ≥80%, ALSFRS‑R item scores ≥2 (retention of most ADLs), initial disease duration ≤2 years, approvals limited to 6 months, and reauthorization only with documented clinical benefit (e.g., slowed ALSFRS‑R decline).

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

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