Repository Corticotropin Injection (H.P. Acthar Gel) — RETIRED
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This document governs coverage and administrative handling for repository corticotropin injection (H.P. Acthar Gel) and informs providers that the policy is retired; it affects providers submitting drug prior authorization requests to CareFirst.
The active policy statement and coverage criteria for repository corticotropin injection have been retired.
Providers must submit all drug prior authorization requests electronically per the notification effective January 1, 2017.
Coverage Criteria and Policy Stance
Coverage stance: This policy is retired. There is no active policy statement or medical necessity criteria provided for repository corticotropin injection (H.P. Acthar Gel) in this document; providers should refer to other current policies or clinical guidance for coverage determinations.
Exclusions and NMN: The retired policy contains no explicit exclusions and provides no explicit not medically necessary (NMN) conditions. Administrative instructions remain in effect—providers must follow electronic prior authorization procedures when submitting requests for this drug.
Coding and Billing
| No codes listed |
Provider Actions and Prior Authorization
Electronic prior authorization — submit via CareFirst Direct
Prior authorization for repository corticotropin injection is handled electronically. Submit PA requests through CareFirst Direct and contact CVS Specialty Pharmacy for questions about covered specialty drugs.
- If already registered for CareFirst Direct: log in at www.carefirst.com/providerlogin and click the Prior Auth/Notification tab.
- If not registered: go to www.carefirst.com/provider and click Register Now.
- For specialty drug questions: call CVS Specialty Pharmacy at 855-264-3237.
Step therapy — none specified
This retired policy does not specify any step therapy requirements.
Electronic prior authorization required — register or log in
Providers must submit all drug prior authorization requests electronically via CareFirst Direct; register for CareFirst provider access if not already registered. Links and instructions are provided on the CareFirst provider site.
- Registered providers: log in at www.carefirst.com/providerlogin and use the Prior Auth/Notification tab to begin the request.
- Unregistered providers: go to www.carefirst.com/provider and click Register Now.
- Provider forms and additional instructions: https://provider.carefirst.com/providers/pharmacy/pharmacy-forms.page
Denial triggers — none specified
No explicit denial triggers are identified in this retired policy document.
Background and Clinical Context
H.P. Acthar Gel (repository corticotropin injection) is described as a naturally derived, highly purified sterile preparation of adrenocorticotropic hormone (ACTH) formulated in gelatin to provide prolonged release after subcutaneous or intramuscular injection. It stimulates adrenal cortical production of endogenous steroids and is pharmacologically distinct from synthetic diagnostic agents such as cosyntropin.
The active policy statement and coverage criteria for this drug have been retired; this document serves as informational background on the product formulation and general properties rather than as an active coverage guideline.
Definitions
Site of Care
No infusion center/site-of-care restrictions
This retired policy does not specify any site-of-care or infusion center restrictions.
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