Repository corticotropin injection (Acthar)

Acthar is covered only as monotherapy for infantile spasms (West syndrome) in infants/children under 2 years with diagnosis confirmed by appropriate testing, for up to 12 months; all off‑label uses are excluded and intravenous use is prohibited. Approval requires documentation of diagnosis and age, absence of listed contraindications (e.g., suspected congenital infection, scleroderma, osteoporosis, systemic fungal infection, ocular HSV, recent surgery, peptic ulcer, CHF, uncontrolled hypertension, porcine protein sensitivity, primary/adrenocortical disorders), and adherence to safety monitoring and vaccine precautions (infection risk, avoid live/attenuated vaccines during immunosuppression, monitor for HPA suppression/Cushing’s, GI risks, and growth).

"Do not approve if any of the following contraindications are present: sensitivity to proteins of porcine origin."