Cortrophin

Generic: corticotropin

40 UNIT/0.5ML — Injection

Also known as: corticotropin CORTROPHIN GEL 80UNIT/ML CORTROPHIN GEL 80UNIT/ML; PRSY 40UNIT/0.5ML, 80UNIT/ML Cortrophin Injection Gel Cortrophin Gel Subcutaneous Prefilled Syringe

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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)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 20 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Clear Silver with $0 Insulin Options via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Expanded Bronze via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Elite Bronze + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Silver + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Gold + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Complete Gold via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Everyday Bronze via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Elite Bronze via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Silver via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Gold via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Everyday Bronze with Atrium Health via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Elite Bronze with Atrium Health via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Focused Silver with Atrium Health via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Complete Gold with Atrium Health via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Expanded Bronze with Atrium Health via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Silver with Atrium Health via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Gold with Atrium Health via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Complete Gold + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental via Acthar	Tier 4 - Non-Preferred	✓	—	—	PA

AmeriHealth Caritas NC

20 plans

Source: CMS QHP JSON · Checked: 20 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Signature + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Premier + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Essential + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals via Acthar	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 5 - Specialty	✓	—	—	PA

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Advantage 2026 via Acthar	Tier 5 - Specialty	✓	—	— Restricted Access; Limited Distribution	PA
BCBSNC Blue Home with UNC Health Alliance 2026 via Acthar	Tier 5 - Specialty	✓	—	— Restricted Access; Limited Distribution	PA
BCBSNC Blue Local 2026 via Acthar	Tier 5 - Specialty	✓	—	— Restricted Access; Limited Distribution	PA
BCBSNC Blue Care 2026 via Acthar	Tier 5 - Specialty	✓	—	— Restricted Access; Limited Distribution	PA
BCBSNC Blue Value 2026 via Acthar	Tier 5 - Specialty	✓	—	— Restricted Access; Limited Distribution	PA

Medicare Part D

10 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 20 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Alignment Health Platinum Select (HMO) via Acthar	Tier 5 - Specialty	✓	—	—	PA
Alignment Health Heart & Diabetes Care (HMO C-SNP) via Acthar	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare (HMO)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health AVA (PPO) via Acthar	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health Platinum (HMO) via Acthar	Tier 5 - Specialty	✓	—	—	PA
Alignment Health NC Duals (HMO-POS D-SNP) via Acthar	Tier 5 - Specialty	✓	—	—	PA
Alignment Health smartHMO (HMO) via Acthar	Tier 5 - Specialty	✓	—	—	PA
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) via Acthar	Tier 5 - Specialty	✓	—	—	PA

NC State Health Plan

6 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Acthar	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 - 80/20 Plus PPO 2026 via Acthar	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026 via Acthar	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - 80/20 Plus PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL