Radicava ORS (edaravone) — Point32Health

Initial criteria

• Documented diagnosis of amyotrophic lateral sclerosis based on one of the following: EI Escorial revised criteria OR Gold Coast criteria
• Prescribed by or in consultation with a neurologist
• Documentation of one of the following: Patient is stable on Rilutek (riluzole) OR Clinical inappropriateness of Rilutek (riluzole)
• Documentation of a score of at least 2 points on each individual item of the ALS Functional Rating Scale – Revised (ALSFRS-R)