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Acthar Gel denials: what the review data shows
Independent reviewers have decided 75 published cases where an insurer denied Acthar Gel — and they overturned the insurer 52% of the time. A denial for Acthar Gel is a starting position, not a final answer.
Published decisions
75
2001–2026
Overturned
52%
39 denials reversed
By condition
Published outcomes when Acthar Gel was denied for these conditions.
| Condition | Decisions | Overturned |
|---|---|---|
| Multiple Sclerosis | 12 | 75% |
| Nephrotic Syndrome | 12 | 91.7% |
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the outcome record for Acthar Gelwhen you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.