Generic name |
edaravone |
|
---|---|---|
Strength / Form |
Oral suspension 105mg/5mL |
Special Authority criteria |
Approval period |
---|---|
Initial coverage For the treatment of amyotrophic lateral sclerosis (ALS), if all the following conditions are met:
AND
AND
AND
AND
AND
|
6 months |
Renewal coverage Approval for renewals will not be granted and coverage will be discontinued in patients who meet any of the following criteria:
AND
OR
|
6 months |
None