Medicare AdvantagePrior AuthLow impact
Radicava® and Radicava ORS® (edaravone) (Revised)
Humana·Neurology·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana revised its Medicare Advantage prior authorization policy for Radicava and Radicava ORS (edaravone) for ALS treatment, effective January 1, 2025. The policy requires patients to meet five specific criteria including ALS diagnosis by a specialist, baseline ALSFRS-R scores, independent ADL performance, disease duration ≤2 years, and concurrent/prior riluzole treatment.
Action Required
By January 1, 2025: Billing team and providers must ensure prior authorization is obtained for all Radicava and Radicava ORS prescriptions for Medicare Advantage patients. Verify patients meet all five criteria: ALS diagnosis by neurologist/specialist, ALSFRS-R score ≥2 per item, independent ADL performance, disease duration ≤2 years, and riluzole treatment history. Document all criteria in patient records as claims may be denied without proper prior authorization.