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Acthar Gel

Drug - H.P. Acthar Gel (corticotropin)

August 2014

Therapeutic area - Miscellaneous

Approval criteria

Acetic acid has antibacterial and antifungal action. Hydrocortisone reduces swelling and relieves pain and itching. This medication is used to treat certain infections of the outer ear and ear canal.

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

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