Purified Cortrophin Gel® (repository corticotropin injection)

Evicore's policy states Purified Cortrophin Gel® should generally not be approved/covered for its FDA‑listed indications (rheumatic, collagen, dermatologic, allergic, ophthalmic, respiratory, edematous, and nervous system disorders) due to insufficient updated efficacy data and potential long‑term safety concerns. No specific documentation requirements, exceptions, or coverage procedures are provided.

"Rheumatic disorders"

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