CommercialCoverageMedium impact
ACTH Gel (Repository Corticotropin Injection)
Blue Cross & Blue Shield of Mississippi·MS · Neurology, Pediatrics, Rheumatology +1 more·Pharmacy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their ACTH Gel (Repository Corticotropin Injection) policy, limiting medically necessary coverage to infantile spasms only. All other FDA-approved indications (multiple sclerosis, rheumatic disorders, etc.) are now considered investigational unless patients have contraindications to standard corticosteroids.
Action Required
Immediately: Billing team must verify patient diagnosis before submitting ACTH Gel claims. Only approve for infantile spasms (West syndrome) without prior auth. For all other conditions, require documentation of corticosteroid contraindications or intolerance before billing, as coverage will be considered investigational. Update prior authorization workflows to reflect these restrictions.