Lemtrada® (alemtuzumab)

Covers Lemtrada (alemtuzumab) for adults ≥17 with relapsing forms of MS (relapsing‑remitting or active secondary progressive) and excludes patients <17 or non‑relapsing MS. Key requirements: must be prescribed by or in consultation with an MS specialist; initial approval requires prior inadequate efficacy or intolerance to two standard DMTs OR one specified high‑efficacy agent (e.g., Kesimpta, Tysabri, Briumvi, Mavenclad, Ocrevus/Ocrevus Zunovo) or documented highly active/aggressive MS per defined clinical/MRI criteria; dosing is 12 mg/day ×5 days for the first course with reauthorization only after completing that 5‑dose course, ≥12 months since last Lemtrada dose and objective or symptomatic evidence of benefit (subsequent courses 12 mg/day ×3 days).

"Lemtrada is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include relapsing-remitting disease and active secondary progressive disease, in adults."