Acthar Gel
Drug - H.P. Acthar Gel (corticotropin)
April 2019
Therapeutic area - Miscellaneous
Approval criteria
If patient diagnosis is infantile spasms or multiple sclerosis:
- Patient cannot be treated with IV methylprednisolone or oral corticosteroids AND
- Accepted treatment guidelines have been followed for the specific disease state
For other disease states:
- Patient cannot be treated with IV methylprednisolone or oral corticosteroids AND
- Provider must state intended use, and provides published and peer reviewed literature supporting use in the specific disease state
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411