Does Medicare Cover Radicava for ALS Treatment?
Last Updated : 09/10/20184 min read
Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease is a progressive condition where the motor neurons that control voluntary muscle movement slowly die. As their muscles weaken and eventually become paralyzed, ALS patients may lose the ability to talk, walk, swallow, or even breathe, according to the ALS Association.
The Food and Drug Administration (FDA) recently approved Radicava as the first new ALS treatment in 22 years.
Learn more about Radicava and other ALS treatment options, as well as how Medicare coverage for Radicava works.
What are ALS treatment options?
There is currently no cure for ALS according to the ALS Association. The average life expectancy for a person with ALS is two to five years from the point of diagnosis, but how quickly the condition progresses varies. According to the ALS Association, ALS treatment through medical intervention and medication may slow the condition’s progression for some people.
Most ALS treatment involves medications to control symptoms. According to the UCSF Medical Center, your doctor may prescribe medications for pain relief, to help you swallow saliva, or to reduce muscle spasms. Some patients may need a feeding tube once they lose the ability to swallow.
Until recently, the only FDA-approved medication available for ALS treatment was riluzole, which may moderately slow the disease’s progression in some patients. Riluzole may delay the need for breathing tube, according to the U.S. National Library of Medicine. In 2017, the FDA approved Radicava as another ALS treatment option.
What is Radicava?
According to the FDA, Radicava is an intravenous infusion drug that must be administered by a health-care professional. If your doctor prescribes Radicava for your ALS treatment, you’ll get a daily dosage for 14 days, followed by a 14-day drug-free period. After this initial cycle is over, subsequent cycles of ALS treatment will involve Radicava being given 10 out of 14 days, followed by a 14-day drug-free period.
How does Radicava work as an ALS treatment option?
According to the ALS Association, Radicava removes excess free radicals from the body. A free radical is a cell by-product that can trigger chemical reactions that cause damage. Scientists theorize that excess free radicals in ALS patients may cause reactions that result in motor neurons being damaged, leading to muscle deterioration. By removing extra free radicals, Radicava may help some patients preserve certain functions longer, although this ALS treatment still isn’t a cure.
Side effects of Radicava during ALS treatment may include bruising, difficulty walking, or inflammation, according to the ALS Association.
Does Medicare cover medications for ALS treatment?
If you need prescription drugs as part of your ALS treatment, Medicare Part B covers limited outpatient prescription drugs (typically the type that you can’t give yourself). As an intravenous medication given by a health care professional, Radicava would likely fall under Part B coverage if your doctor prescribes it as part of your ALS treatment. You’re responsible for a 20% coinsurance and the Part B deductible if you get the ALS treatment with a provider that accepts assignment. If you get the ALS treatment in a hospital outpatient setting, you may owe a copayment.
Medicare Part D covers prescription drugs not otherwise covered under Part B, including medications for ALS treatment, such as those to manage symptoms. Your ALS treatment plan may include medications like baclofen, which reduces muscle stiffness; or amitriptyline, a medication that helps you swallow and reduces the risk of choking, according to the University of California San Francisco Medical Center.
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