It is common for an insurance company to require additional paperwork to determine coverage, and this process may take some time. The Acthar Gel support team will be here to help every step of the way.

Getting started is simple

Complete the Acthar Referral Form and fax it to the Acthar Patient Support Team at 1-877-937-2284.
The Acthar Patient Support Team faxes back a confirmation and contacts the office within 4 business hours to explain next steps, including prior authorization requirements.
The Acthar Patient Support Team may contact the office staff with questions. Responding in a timely manner helps ensure patients get Acthar Gel as soon as possible.

If you have any questions, contact the Acthar Patient Support Team:

Phone: 1-888-435-2284

Fax: 1-877-937-2284

The Case Manager at the Acthar Patient Support Team will keep office staff and patients informed about the status of their Acthar Gel prescription.

The Acthar Patient Support Team

The Patient Support Team works with physician offices to determine patient coverage and manage payer-specific requirements, including steps edits, prior authorizations, Letters of Medical Necessity, and appeals. It is common for an insurance company to require additional paperwork to determine coverage, and this process may take some time. The Acthar Gel support team will be here to help every step of the way.

For eligible patients with commercial insurance:

  • Assistance may be available through the Commercial Co-pay Program, which is paid for and sponsored by Mallinckrodt (see Terms and Conditions)
  • Patients may be enrolled in the program by their Case Manager or Specialty Pharmacy

For patients with government insurance:

  • An Independent Charitable Foundation (ICF) may provide funding for eligible government-insured patients seeking financial support
  • Mallinckrodt does not determine ICF fund-eligibility criteria, or have any influence over the patients chosen or types of assistance provided
  • Case Managers at the Patient Support Team will provide information about fund availability, ICF contact information, and instructions for preparing any required documentation to government-insured patients with a valid, on-label prescription for Acthar Gel
  • Patients will be responsible for applying for funds and working with the ICF

For patients without insurance coverage:

  • Acthar Gel may be available at no cost to eligible uninsured, underinsured, or rendered uninsured patients with a valid, on-label prescription*
  • Case Managers will transfer appropriate patients to the Acthar Patient Assistance Program to determine eligibility*

*Acthar Patient Assistance Program patient eligibility criteria:

  • Valid Acthar Gel prescription for an FDA-approved indication
  • Permanent US resident
  • Household income at or below 700% of the Federal Poverty Level
  • Patients may be subject to random income verification to determine eligibility

Program administered via a third-party organization.

Product Delivery

  • Acthar Gel and all necessary injection supplies will be shipped from a Specialty Pharmacy directly to patients’ homes
  • The Specialty Pharmacy will schedule delivery with patients because each prescription requires a signature

Injection Training

  • Injection training by a licensed nurse is available at no cost through the Acthar Patient Support Team
  • Training may be provided at a home visit, through an online session, or over the phone
  • Prescribers may request injection training by contacting their Case Manager or completing the Acthar Referral Form. If a patient requests injection training, the Case Manager will confirm with the prescriber and follow up for appropriate paperwork

Helpful Resources

Request a rep visit

Contact your Acthar Gel sales specialist.

Acthar Referral Form

Download, complete, and fax the Referral Form to order Acthar Gel for your appropriate patients.

Caregiver Injection Training and Starter Kit

Information about Infantile Spasms and how to inject Acthar Gel.