Does Medicare Cover Radicava?

Unfortunately there currently is no cure for amyotrophic lateral sclerosis (ALS). However there are some FDA-approved medications that can help.

One of these treatments is Edaravone, also known by its brand name, Radicava. It’s an expensive medication though so a common question for those over the age of 65 is “does Medicare cover Radicava”?

In this article, we answer that question in clear, plain English. You’ll also find the average costs of Radicava as well as other helpful info.

The short answer is, yes, Medicare will cover the cost of Radicava. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for Radicava. Below we look at what these are so you know what to expect.

Medicare often covers Radicava if you need it to treat your ALS. Radicava is an intravenous medication that must be given by a medical professional. Medicare Part B covers limited outpatient prescription drugs and this is one of them.

Though Medicare Part B provides coverage, the ALS treatment must be administered at a doctor’s office. Otherwise, they will not provide coverage for the treatment.

As per usual, Medicare Part B will cover 80% of the cost. And you will be responsible for the rest of the 20% if you find a provider that accepts the assignment.

Also, if you get the ALS treatment in an outpatient hospital setting, you may owe a copayment.

Aside from Medicare Part B, Medicare Part D also covers prescription drugs, in which ALS treatment is included. Your ALS treatment plan may consist of baclofen or amitriptyline. Baclofen is a medication that reduces stiffness in the muscles. And amitriptyline can help you swallow, thus decreasing the risks of choking.

How Much Does Radicava Cost?

This kind of medication does not come cheap.

A single shot of Radicava can cost about $1,000 and it costs about $11,000 per dosage cycle. A year’s treatment will likely cost about $146,000.

Because the treatment is so expensive, most patients needed prescription drug coverage and supplemental insurance to make it affordable. However, even with insurance, a single dose of Radicava can cost $200. A year’s treatment can cost around $29,000.

What Is ALS?

Amyotrophic Lateral Sclerosis, or in short, ALS, is a progressive condition that leads to paralysis. While suffering the illness, the motor neurons will slowly weaken and then die, leading to paralysis. Motor neurons control voluntary muscle movement.

Aside from losing mobility in all parts of your body, the worst-case scenario with this disease is losing the ability to breathe. There are ways to treat this condition that are FDA-approved. One of those treatments is Radicava.

What Is Radicava?

Radicava is one of the two major brands of Edaravone. Though this medication is only used for treating patients who suffered from strokes in the past, the FDA approved this for treating early-stage ALS. Even though this is a treatment for ALS, it is not the cure for it.

Medicare Part B and Part D cover Radicava as a treatment for ALS. However, if it is not administered in a doctor’s office, Medicare will not cover them.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.