Edaravone Injection (Radicava)

Radicava (edaravone) is covered only for the FDA‑approved indication of ALS (other uses excluded) in patients with a "definite" or "probable" ALS diagnosis per El Escorial/revised Airlie House criteria. Coverage requires ALSFRS‑R ≥2 on every item, percent‑predicted FVC ≥80%, diagnosis ≤2 years, prior or current riluzole therapy, prescription by or in consultation with an ALS specialist; initial authorization is 6 months and reauthorization (1 year) requires documented ongoing benefit and no invasive ventilation.

"Only patients with the FDA-approved indication (ALS) are eligible; other uses are not supported by these coverage guidelines."

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