UnitedHealthcare
Radicava (edaravone)
Drugs for Nerves and Muscles : Drugs for Nerves and Muscles
  • Prior Authorization: Amyotrophic Lateral Sclerosis (ALS):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 168 Day(s)
    Reauthorization Required: Yes

  • Amyotrophic Lateral Sclerosis (ALS):
    Duration: 168 Day(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Neurologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 168 day(s)

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