Repository corticotropin injection (Acthar)

Acthar Gel is covered only as monotherapy for FDA‑approved infantile spasms (West syndrome) in infants/children under 2 years; other FDA‑approved indications are not automatically covered and require medical director review. Approval requires documented diagnosis and age, prescription by or in consultation with a neurologist, a 1‑month authorization with dosing 150 U/m2 IM (75 U/m2 twice daily) and a taper after 2 weeks over 2 weeks, and meeting applicable safety criteria.

"Acthar is prescribed by or in consultation with a neurologist (prescriber/consult requirement)."

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