Exservan (riluzole) — Highmark
amyotrophic lateral sclerosis (ALS)
Initial criteria
- Diagnosis of amyotrophic lateral sclerosis (ALS)
- Member has an inability to swallow tablets
Reauthorization criteria
- Continued need for a non-solid oral dosage form of riluzole due to inability to swallow tablets
- Diagnosis of amyotrophic lateral sclerosis (ALS)
Approval duration
12 months