Edaravone – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers intravenous edaravone for amyotrophic lateral sclerosis (oral Radicava ORS is excluded from the medical benefit and must be obtained via pharmacy) only when strict criteria are met: documented ALS diagnosis with baseline ALSFRS‑R item scores ≥2 and %FVC ≥80% (initial), provider attestation that the patient/caregiver cannot administer the oral suspension, prescription by or in consultation with an ALS‑experienced neurologist, dosing per FDA labeling, submission of supporting medical records, and authorizations limited to up to 12 months. Continuation coverage requires ongoing edaravone therapy, no dependence on invasive ventilation, the same documentation and dosing/neurologist requirements, and is subject to member‑specific plan terms.

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