Acthar Prescription Assistance Programs

Acthar: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Acthar. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Acthar Support & Access Program (A.S.A.P)

(Program 1 of 1 — Scroll down to see them all )

Provided by: Mallinckrodt Pharmaceuticals
None
TEL: 888-435-2284
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Acthar (corticotropin)
Eligibility Requirements
  • Insurance Status *Contact program for details.
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must permanently reside in the US and be under the direct care of a US Physician
Application
  • Obtaining Doctor/Doctor's office must call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Within 2-3 days
Medication
  • Amount/Supply Varies
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
This program also provides copay assistance.
Updated March 18, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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