Skip to content
The Policy VaultThe Policy Vault

Purified Cortrophin Gel (repository corticotropin injection USP) — United Healthcare

Opsoclonus-myoclonus syndrome (Kinsbourne Syndrome)

Initial criteria

  • Diagnosis of opsoclonus-myoclonus syndrome (Kinsbourne Syndrome)

Reauthorization criteria

  • All requests for reauthorization will be denied; continuation must be submitted through the appeals process.

Approval duration

3 months