Payer PolicyActive
Purified Cortrophin Gel® (repository corticotropin injection)
EVICORE-MEDICAL_DRUG-2CEE6A0B
EviCore by Evernorth
Effective: January 1, 2026
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Purified Cortrophin Gel is not recommended for approval/coverage—although FDA‑approved indications are listed (rheumatic, collagen, dermatologic, allergic, ophthalmic, respiratory, edematous, and nervous system disorders), current evidence is insufficient and there are potential long‑term safety concerns. If requested, the patient must have one of the FDA‑approved diagnoses and meet specific coverage criteria, but approval is still discouraged given the lack of demonstrated benefit over other therapies.
Coverage Criteria Preview
Key requirements from the full policy
"Rheumatic disorders"
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