CommercialCoverageMedium impact
08.01.12e, Repository Corticotropin Injection (Acthar® Gel, Purified Cortrophin® Gel)
Independence Blue Cross·Pharmacy, Endocrinology, Rheumatology +2 more·Pharmacy
Effective date
Aug 20, 2025
We identified it
Jun 19, 2026
Summary
This is a reissued policy for Repository Corticotropin Injection (Acthar® Gel, Purified Cortrophin® Gel) effective 08/20/2025. The policy document title and reissue date are provided, but the specific coverage criteria, billing codes, prior authorization requirements, and clinical guidelines are not included in the source material provided. The billing team must obtain the full policy text to understand what changed from the previous version and what actions are required.
Action Required
By 08/20/2025: Billing team must obtain and review the complete full policy text for 08.01.12e Repository Corticotropin Injection from the source URL (https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=08&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-01-12e). Compare the reissued policy against the previous version to identify specific changes to coverage criteria, billing codes (CPT/HCPCS), prior authorization requirements, medical necessity documentation, and reimbursement rates. Update billing software, encounter forms, and provider guidance accordingly. Alert providers and billing staff of any changes to Acthar® Gel or Purified Cortrophin® Gel claim submission requirements. Without the full policy text, specific billing code changes and prior auth requirements cannot be determined from this notification alone.