MedicaidPrior AuthMedium impact
Prior Authorization of Radicava (edaravone) – Pharmacy Services MAB 01-19-03
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Prior Authorization
Effective date
Jan 22, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all prescriptions of Radicava (edaravone), an ALS medication. Strict clinical criteria must be met including neurologist prescribing, disease duration <2 years, and combination with riluzole.
Action Required
Effective January 22, 2019: Billing team must update prior authorization workflow for Radicava (edaravone) prescriptions for Pennsylvania Medicaid patients. Ensure neurologists document ALSFRS-R scores, disease duration <2 years, FVC ≥80%, and combination therapy with riluzole before submitting claims. Claims without prior authorization will be denied.