Edaravone Injection (CPB 0918, reviewed 2026-07-02)
Summary
Aetna requires precertification for edaravone (Radicava and generic formulations) injection for all participating providers and members in applicable plan designs, and the Site of Care Utilization Management Policy applies. Aetna considers edaravone medically necessary for amyotrophic lateral sclerosis (ALS) when the initial criteria are met, and for continuation of therapy when the continuation criteria are met. Aetna considers all other indications experimental, investigational, or unproven, including Alzheimer's disease, Parkinson disease, multiple sclerosis, acute ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and rheumatoid arthritis. The recommended dose is 60 mg given as an intravenous infusion over 60 minutes. The first treatment cycle is daily dosing for 14 days followed by a 14-day drug-free period, and later cycles are daily dosing for 10 days out of each 14-day period followed by a 14-day drug-free period. Historical note: promotion, distribution, and production of Radicava IV were set to end as early as April 1, 2025.
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