Alemtuzumab (Lemtrada)

Covered: Lemtrada is authorized for relapsing forms of MS in patients ≥17 when prescribed by or in consultation with an MS specialist; it is excluded for patients <17, non‑FDA indications (e.g., primary progressive MS), or without required documentation. Key requirements: initial approval requires failure/intolerance to two prior DMTs OR documented highly‑active/aggressive disease and is limited to a 5‑day (12 mg/day IV) course; reauthorization requires ≥12 months since the last Lemtrada course, documentation of prior treatment dates and supporting clinical/MRI evidence, and is limited to a 3‑day (12 mg/day IV) course.

"Lemtrada is indicated for the treatment of relapsing forms of multiple sclerosis (MS)."

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