Neuromyelitis optica spectrum disorder: all criteria

Every recorded criterion by drug and payer. Evaluated criteria drive the eligibility tool. Narrative requirements are shown but not evaluated. Last content update 2026-10-20.

Drug	Payer	Pathway	Evaluated criteria	Also required / notes	Sources and verification
methylprednisolone IV (acute relapse)	All payers	Hospital procedure	None	Hospital-administered acute relapse treatment funded through AHS. Not dependent on the patient's drug plan. Typically 1 g daily for 3 to 5 days.	Draft 2026-10-20
plasma exchange (PLEX)	All payers	Hospital procedure	None	Hospital-administered procedure funded through AHS. Not dependent on the patient's drug plan. Used for severe relapses or inadequate response to IV steroids; earlier use is associated with better recovery.	Draft 2026-10-20
prednisone	All payers	Regular benefit	None	Regular benefit. Used as an oral taper after a relapse and as bridging while a steroid-sparing agent takes effect.	Alberta Drug Benefit List Draft 2026-10-20
azathioprine Imuran	All payers	Regular benefit	None	Regular benefit. Accepted by Alberta as an alternative adequate trial when rituximab is not appropriate. Consider TPMT testing before initiation.	Alberta Drug Benefit List Draft 2026-10-20
mycophenolate mofetil CellCept	All payers	STEDT approval	None	Requires approval through the AHS Short Term Exceptional Drug Therapy (STEDT) program for the NMOSD indication. Funding is through AHS and does not depend on the patient's insurer.	AHS STEDT program (locate current request form) Draft 2026-10-20 Add direct STEDT form link.
rituximab Rituxan and biosimilars	All payers	STEDT approval	None	Requires approval through the AHS Short Term Exceptional Drug Therapy (STEDT) program. Funding is through AHS and does not depend on the patient's insurer. The usual first-line preventive therapy in Alberta, and an adequate trial is a prerequisite for the listed biologics unless rituximab is inappropriate. Also the usual choice for MOG-IgG positive and double seronegative disease, which the listed biologics do not cover.	AHS STEDT program (locate current request form) Draft 2026-10-20 Add direct STEDT form link and documented prerequisites.
satralizumab Enspryng	Alberta government plan	Special authorization Alberta Blue Cross form ABC 60116, Inebilizumab / Ravulizumab / Satralizumab for NMOSD (2026/02)	Antibody status is AQP4-IgG positive Prior rituximab is one of Relapsed despite an adequate trial, Intolerant or contraindicated, another preventive therapy tried Relapse history is one of At least 1 relapse in the past 12 months Current EDSS ≤ 6.5 Currently in an acute relapse is no	Prescribed by a Neurologist. Alberta wording for the prior therapy criterion: refractory to or intolerant of an adequate trial of rituximab for NMOSD; if rituximab is not appropriate, an adequate trial of another preventative treatment (other monoclonal antibodies, azathioprine, mycophenolate or other immunosuppressants) must have been used. Initial coverage: 120 mg at weeks 0, 2 and 4, then 120 mg every 4 weeks, for 12 months. Pharmacy dispensing limited to three doses per prescription during the first four weeks, then one dose per prescription. Continued coverage beyond 12 months: the Neurologist must provide a current EDSS, which must be less than 8.0 at each renewal. Renewals approved for up to 6 months at a time. Switching between biologic agents is permitted after an adequate trial (at minimum completion of induction dosing) if unresponsive, or for serious adverse effects or contraindications. Patients deemed unresponsive to satralizumab may not switch back to it. Not covered in combination with a biologic agent, including rituximab, for NMOSD. Alberta also covers adolescents aged 12 and over; this version of the tool is for adults.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) Alberta Drug Benefit List update effective November 1, 2025, satralizumab criteria (copy in docs/sources) Form ABC 60116 (2026/02) (copy in docs/sources) CADTH reimbursement recommendation SR0663 (satralizumab), 2021 Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	This insurer does not publish its prior authorization criteria. Expect prior authorization with criteria tracking the CDA-AMC recommendation; the Alberta government plan criteria are a reasonable guide.	Submit the insurer's own prior authorization form.	Draft 2026-10-20
	NIHB, VAC	Not published	Federal program listing status not confirmed. Criteria, where listed, generally align with the CDA-AMC recommendation.		Draft 2026-10-20
	No coverage	Not published	No drug plan on file. Any Alberta resident can enrol in Alberta Non-Group Coverage (premium-based) and then apply under the Alberta government plan criteria. The manufacturer patient support program may bridge while coverage is arranged.		Alberta Non-Group Coverage Draft 2026-10-20
inebilizumab Uplizna	Alberta government plan	Special authorization Alberta Blue Cross form ABC 60116, Inebilizumab / Ravulizumab / Satralizumab for NMOSD (2026/02)	Antibody status is AQP4-IgG positive Prior rituximab is one of Relapsed despite an adequate trial, Intolerant or contraindicated, another preventive therapy tried Relapse history is one of At least 1 relapse in the past 12 months, None in 12 months, but at least 2 in the past 24 months Current EDSS ≤ 8 Currently in an acute relapse is no	Adults aged 18 and over. Prescribed by a Neurologist. Alberta accepts, for inebilizumab, at least two relapses in the previous 24 months as an alternative to one relapse in the previous 12 months. Initial coverage 12 months: 300 mg IV at weeks 0 and 2, then 300 mg every 6 months. Two doses per prescription in the first two weeks, then one. Continued coverage beyond 12 months: the Neurologist must provide a current EDSS, which must be 8.0 or lower at each renewal. Renewals approved for up to 12 months. Switching from one biologic agent to another is permitted after an adequate trial of the previous drug (at minimum completion of induction dosing) if unresponsive, or for serious adverse effects or contraindications. Patients deemed unresponsive may not switch back. Not covered in combination with a biologic agent, including rituximab, for NMOSD.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) Form ABC 60116 (2026/02) (copy in docs/sources) CDA-AMC reimbursement review SR0793 (inebilizumab) Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	This insurer does not publish its prior authorization criteria. Expect prior authorization with criteria tracking the CDA-AMC recommendation.	Submit the insurer's own prior authorization form.	Draft 2026-10-20
	NIHB, VAC	Not published	Federal program listing status not confirmed.		Draft 2026-10-20
	No coverage	Not published	No drug plan on file. Any Alberta resident can enrol in Alberta Non-Group Coverage (premium-based) and then apply under the Alberta government plan criteria. The manufacturer patient support program may bridge while coverage is arranged.		Alberta Non-Group Coverage Draft 2026-10-20
ravulizumab Ultomiris	Alberta government plan	Special authorization Alberta Blue Cross form ABC 60116, Inebilizumab / Ravulizumab / Satralizumab for NMOSD (2026/02)	Antibody status is AQP4-IgG positive Prior rituximab is one of Relapsed despite an adequate trial, Intolerant or contraindicated, another preventive therapy tried Relapse history is one of At least 1 relapse in the past 12 months Current EDSS ≤ 7 Currently in an acute relapse is no	Adults aged 18 and over. Prescribed by a Neurologist. Meningococcal vaccination is required by the product monograph; it is not stated in the Alberta NMOSD criteria. Initial coverage 12 months: weight-based loading dose, maintenance at week 2, then every 8 weeks. One dose per prescription. Continued coverage beyond 12 months: the Neurologist must provide a current EDSS, which must be 8.0 or lower at each renewal. Renewals approved for up to 12 months. Switching from one biologic agent to another is permitted after an adequate trial of the previous drug (at minimum completion of induction dosing) if unresponsive, or for serious adverse effects or contraindications. Patients deemed unresponsive may not switch back. Not covered in combination with a biologic agent, including rituximab, for NMOSD.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) Form ABC 60116 (2026/02) (copy in docs/sources) CDA-AMC reimbursement recommendation SR0785 (ravulizumab, NMOSD), 2024 Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	This insurer does not publish its prior authorization criteria. Expect prior authorization with criteria tracking the CDA-AMC recommendation.	Submit the insurer's own prior authorization form.	Draft 2026-10-20
	NIHB, VAC	Not published	Reported as covered by NIHB for AQP4 positive NMOSD. Criteria generally align with the CDA-AMC recommendation. Confirm against the program's current drug benefit list.		Manufacturer announcement of public listings for NMOSD Draft 2026-10-20
	No coverage	Not published	No drug plan on file. Any Alberta resident can enrol in Alberta Non-Group Coverage (premium-based) and then apply under the Alberta government plan criteria. The manufacturer patient support program may bridge while coverage is arranged.		Alberta Non-Group Coverage Draft 2026-10-20
eculizumab Soliris and biosimilars	Alberta government plan	Not listed	Not on Alberta's NMOSD special authorization form, and Section 3 lists eculizumab for hematologic indications only. CADTH recommended eculizumab with conditions in 2020 (at least 2 relapses in 12 months or 3 in 24), but Alberta has not listed it for NMOSD.	Ravulizumab is the listed C5 inhibitor for NMOSD in Alberta.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	Private coverage of eculizumab for NMOSD varies and is not published.		Draft 2026-10-20
	NIHB, VAC	Not published	Federal program listing status for NMOSD not confirmed.		Draft 2026-10-20
	No coverage	Not listed	Not publicly listed for NMOSD in Alberta, so Non-Group Coverage enrolment would not provide access. Manufacturer compassionate programs are the only route.		Draft 2026-10-20

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