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 or go to the program website.

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Acthar Patient Assistance Program

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

Provided by: Mallinckrodt Pharmaceuticals
TEL: 844-231-3050
ALT PHONE: 844-231-3050
FAX: 877-937-2284
Languages Spoken:
Program Website
  • Acthar (corticotropin)
Eligibility Requirements
  • Insurance Status Must be uninsured or underinsured
  • Those with Part D Elibible? Contact program for details.
  • Income At or below 700% of FPL
  • 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
  • Obtaining Doctor must start by faxing enrollment form to program
  • Receiving Faxed or downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Doctor notified
  • Decision Timeframe Not specified
  • Amount/Supply Contact the program for more details.
  • Sent To Not specified
  • Delivery Time Contact Program for Details
  • Refill Proces Contact program for details.
  • Limit Contact the program for details
  • Re-application Contact program for details.
Additional Information
Updated July 11, 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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