Summary
This is a historical Humana prior authorization policy for corticotropin products (Acthar Gel, Cortrophin Gel) that became effective January 1, 2025 and was last revised March 25, 2026. The policy establishes prior authorization requirements for four indications: West Syndrome in infants under 2 years, acute MS exacerbations, acute exacerbations of rheumatic/collagen/ophthalmic diseases and nephrotic syndrome, and symptomatic sarcoidosis. Billing teams should verify current applicability with Humana, as the source advises checking online for the most up-to-date version before using this policy.
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What to do
Action · 4 steps
01Already effective as of January 1, 2025: Verify whether the practice has implemented prior authorization workflows for corticotropin products (Acthar Gel, Cortrophin Gel, Acthar Selfject, Cortrophin Gel subcutaneous syringe) across the four listed indications for Humana Medicare and Medicaid members in Kentucky and South Carolina.
02Confirm current applicability by checking Humana's online policy portal, as the source explicitly states that printed copies become uncontrolled and recommends verifying the current version before utilization.
03If not yet implemented, billing team should update prior authorization submission processes to require: (1) for West Syndrome—member under 2 years old with neurologist/epileptologist prescription; (2) for MS exacerbations—current DMT use (unless CIS or DMT contraindicated), neurologist prescription, and documented failure of recent 3-day corticosteroid trial or contraindication/intolerable side effects; (3) for rheumatic/collagen/ophthalmic/nephrotic conditions—documented failure of corticosteroid trial or contraindication/intolerable side effects; (4) for sarcoidosis—trial or inability to use at least one alternative medication (methotrexate, azathioprine, infliximab, adalimumab).
04Claims will be denied without required prior authorization documentation.
Original notice
Corticotropin Products (Revised)
mcp.humana.com · Always check the source before changing claims.