Radicava® (edaravone)

Radicava (edaravone) is covered for ALS only when all initial criteria are met — a definite or probable ALS diagnosis by El Escorial/Airlie House criteria, ALSFRS‑R score ≥2 on every item, percent‑predicted FVC ≥80%, diagnosis within 2 years, prior or current riluzole therapy, and prescription by or in consultation with an ALS specialist — otherwise excluded. Authorizations are 6 months, require documentation (diagnosis, ALSFRS‑R, PFTs, riluzole use, specialist note and infusion/dosing records) and re‑authorization requires documented continued benefit and that the patient does not require invasive ventilation.

"Radicava is indicated for the treatment of amyotrophic lateral sclerosis (ALS)."

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