Acthar
Generic: corticotropin
40UNIT/0.5ML, 80UNIT — Injection
Also known as:
ACTHAR GEL 80UNIT/ML
ACTHAR GEL PEN 40UNIT/0.5ML, 80UNIT/ML
corticotropin
Acthar Gel
Acthar Injection Gel
Acthar Gel Subcutaneous Auto-injector
Corticotropin
Acthar Gel Subcutaneous Pen-injector
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Enhanced CHF Heart Care Silver $0 Rx Options | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver $0 Rx Options | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Everyday Bronze | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Elite Bronze | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Clear Silver with $0 Insulin Options | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Expanded Bronze | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Silver | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Gold | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Elite Bronze with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Focused Silver with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Complete Gold with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Expanded Bronze with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Silver with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Gold with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Complete Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Everyday Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Elite Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Expanded Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Silver + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Signature Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Complete Gold | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Clear Silver with $0 Insulin Options + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Streamlined Silver | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Streamlined Silver with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
AmeriHealth Caritas NC
22 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Cortrophin |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Cortrophin |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access; Limited Distribution | PA |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access; Limited Distribution | PA |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access; Limited Distribution | PA |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access; Limited Distribution | PA |
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access; Limited Distribution | PA |
Medicare Part D
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health smartHMO (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Platinum Select (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health AVA (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Platinum (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via Cortrophin |
Tier 5 - Specialty | ✓ | — | — | PA |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - HDHP 2026 | Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Cortrophin |
Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - HDHP 2026
via Cortrophin |
Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Cortrophin |
Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |