Payer PolicyActive
Repository corticotropin injection (Purified Cortrophin Gel)
EVICORE-MEDICAL_DRUG-C199843C
EviCore by Evernorth
Effective: April 1, 2022
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Purified corticotropin gel is not recommended for approval/coverage due to insufficient updated efficacy data and potential long‑term safety concerns, effectively excluding its use despite listed FDA‑approved indications (rheumatic, collagen, dermatologic, allergic, ophthalmic, respiratory, edematous, nervous system). Requests can only be considered for FDA‑approved indications with documentation of the diagnosis and that the request meets the specific coverage guidelines, but evidence does not show benefit over available therapies.
Coverage Criteria Preview
Key requirements from the full policy
"Allergic states"
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