Repository corticotropin injection (Acthar Gel, Cortrophin Gel)
Policy covers prior authorization, coverage criteria, dosing limits, and billing codes for repository corticotropin injection (Acthar Gel and Cortrophin Gel) for specified indications (infantile spasms and multiple sclerosis) for Viva Health commercial/non-Medicare lines; includes renewal, dosing, HCPCS and NDC information.
Policy includes indication-specific max units per dosing interval and HCPCS/NDC coding for Acthar and Cortrophin.
Coverage Summary
Policy status: covered_with_criteria for repository corticotropin injection products Acthar Gel and Cortrophin Gel for the listed, covered indications: infantile spasms (West Syndrome) and multiple sclerosis, acute exacerbation. This policy applies to Viva Health commercial/non‑Medicare lines. Prior authorization is required — initial authorization is valid for 1 month and may be renewed monthly; providers must submit documentation that meets the indication‑specific criteria outlined in the policy (see provider actions / prior_auth and documentation requirements).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.