CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - ACTH Gel (Repository Corticotropin Injection)
Blue Cross & Blue Shield of Mississippi·MS · Pediatrics, Neurology, Endocrinology +1 more·Pharmacy
We identified it
Jun 20, 2026
Summary
New policy for State and School Employees' Health Insurance Plan establishes coverage criteria for ACTH Gel (Repository Corticotropin Injection). The medication is considered medically necessary only for infantile spasms, while use for other corticosteroid-responsive conditions is considered investigational unless patients have contraindications to standard corticosteroids.
Action Required
Immediately: Review any existing claims or prior authorizations for Repository Corticotropin Injection (H.P. Acthar Gel). Ensure claims are only submitted for infantile spasms indication or for patients with documented contraindications to corticosteroids. Update prior authorization processes to verify medical necessity criteria before administration.