Alemtuzumab (Lemtrada)

Lemtrada (alemtuzumab) is covered only for relapsing forms of MS (RRMS, SPMS with relapses, PRMS) in patients ≥17 years and is limited to the FDA‑approved indication (non‑relapsing progressive MS is not covered). Coverage requires an MS specialist prescriber or consult, documentation of age/diagnosis/prior treatments, either failure or intolerance of two DMTs or evidence of highly active/aggressive disease per policy definitions, an initial 12 mg/day ×5‑day course and a single allowable reauthorization of 12 mg/day ×3 days approximately 12 months after the first, with timing/dosing and supporting clinical/MRI documentation.

"Relapsing forms of multiple sclerosis"

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