Alemtuzumab (Lemtrada)

Lemtrada (alemtuzumab) is covered for FDA‑approved relapsing forms of MS in patients ≥17 when prescribed by or in consultation with an MS specialist; use in patients <17 or for non‑FDA indications is not covered. Initial approval requires documented failure or intolerance to two prior DMTs OR evidence of highly‑active/aggressive disease per specified clinical/MRI criteria, with dosing per label (initial course 12 mg IV daily ×5 days; additional courses ≥12 months after prior course 12 mg IV daily ×3 days) and supporting documentation of diagnosis, prior therapies/MRI/relapse, specialist involvement, and prior Lemtrada treatment dates for reauthorization.

"FDA-approved indication: Lemtrada is indicated for the treatment of relapsing forms of multiple sclerosis (MS)."

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