Topic

Acthar Gel (repository corticotropin injection)

A collection of 26 issues

Work With Your Doctor to Get Acthar Gel Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box Getting Acthar Gel (repository corticotropin injection) covered by Cigna in North Carolina requires prior authorization approval before dispensing through Express Scripts' Accredo specialty pharmacy. Your fastest path: (1) Verify your diagnosis meets Cigna's approved conditions (infantile spasms, MS exacerbations, rheumatologic disorders), (2) Document corticosteroid failure/

How to Get Acthar Gel Covered by Humana in Washington: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Acthar Gel Covered by Humana in Washington Humana Medicare Advantage requires prior authorization for Acthar Gel (repository corticotropin injection) under their Corticotropin Products policy. Coverage applies to FDA-labeled indications like infantile spasms and MS exacerbations, with documented corticosteroid failure required for most conditions except infantile spasms. First

How to Get Acthar Gel Approved by UnitedHealthcare in California: Prior Authorization Guide & Appeal Process

Answer Box: Getting Acthar Gel Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Acthar Gel (repository corticotropin injection) with strict medical necessity criteria limited to infantile spasms under age 2 and opsoclonus-myoclonus syndrome. Step therapy requiring documented failure of high-dose corticosteroids is mandatory for most conditions. If denied,

Renewing Acthar Gel Coverage with UnitedHealthcare in New Jersey: Complete Timeline and Documentation Guide

Answer Box: Renewing Acthar Gel with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization renewal for Acthar Gel, but all reauthorization requests are automatically denied for most conditions—continuation requires appealing to the UHC Pharmacy appeals team. Start your renewal process 2-4 weeks before your current authorization expires to avoid

UnitedHealthcare's Coverage Criteria for Acthar Gel in Florida: What Counts as "Medically Necessary"?

Answer Box: Getting Acthar Gel Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Acthar Gel with strict medical necessity criteria. Coverage is primarily limited to infantile spasms in children under 2 years old (4-week approval) and select conditions like opsoclonus-myoclonus syndrome. Most other uses require documented failure of

How to Get Acthar Gel Covered by Humana in New York: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Acthar Gel Covered by Humana in New York Humana requires prior authorization for Acthar Gel under their Corticotropin Products policy (effective 2024). For approval, you need: (1) documented covered indication like infantile spasms or MS exacerbations, (2) proof of corticosteroid failure/intolerance except for infantile spasms, and

How to Get Acthar Gel Covered by Cigna in Illinois: Complete Forms, Appeals, and Approval Guide

Answer Box: Getting Acthar Gel Covered by Cigna in Illinois Cigna requires prior authorization for Acthar Gel with strict step therapy requirements. In Illinois, you have 180 days to file internal appeals and 4 months for external review after final denial. First step today: Download Cigna's drug-specific PA

How to Get Acthar Gel Covered by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Acthar Gel Approved by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for all Acthar Gel (repository corticotropin injection) uses in Washington. The fastest path to approval: (1) Submit a complete Statement of Medical Necessity documenting failed corticosteroid therapy, (2) Call Aetna Specialty Pharmacy

Work With Your Doctor to Get Acthar Gel Approved by UnitedHealthcare in Pennsylvania: Complete Provider Collaboration Guide

Answer Box: Fast Track to Acthar Gel Approval Getting Acthar Gel covered by UnitedHealthcare in Pennsylvania requires strong provider partnership. Your doctor must submit prior authorization showing failed corticosteroids and medical necessity for your specific condition (infantile spasms, MS exacerbation, or other labeled indication). If denied, you have internal appeals

How to Get Acthar Gel Covered by Blue Cross Blue Shield in Ohio: Prior Authorization Forms, Appeals Process, and Success Strategies

Quick Answer: Getting Acthar Gel Covered in Ohio Getting Acthar Gel (repository corticotropin injection) approved by Blue Cross Blue Shield in Ohio requires prior authorization for all patients. The fastest path: verify your BCBS plan covers the medication, gather documentation of failed corticosteroid trials, and submit through your provider'