Lemtrada® (alemtuzumab)

Authorization form

Medicare (01/2019)

Lemtrada is not covered for Traditional, Optimized or Medicaid plans

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page

Code(s): J0202

Benefit: Medical

Notes: Treatment of multiple sclerosis