Acthar

(corticotropin)
Acthar H.P. Gel 80 UNT/ML Injectable Solution
NO BOXED WARNING

Dosage & administration

drug label

Acthar prescribing information

prior authorization

Acthar prior authorization resources

Most recent Acthar prior authorization forms

View By Payer
Verified: Feb 07, 2024Kaiser Foundation Health Plan - Chronic High-Dose Opioid Therapy Prior Authorization Form Washington
Verified: Feb 03, 2024UPMC Health Plan - Acthar Gel Prior Authorization Form
Verified: Feb 01, 2024Highmark BCBS Northeastern NY - Medical Injectable Specialty Drug Prior Authorization Form
Verified: Feb 01, 2024Highmark BCBS Northeastern NY - Outpatient Chemotherapy Prior Authorization Form (Medical Benefit)
Verified: Feb 01, 2024Highmark BCBS Northeastern NY - Specialty Drug Prior Authorization Form

Most recent state uniform prior authorization forms

Verified: Jan 28, 2024Oregon - Uniform Prior Authorization Form
Verified: Jan 28, 2024Colorado - Uniform Prior Authorization Form
Verified: Jan 28, 2024Michigan - Uniform Prior Authorization Form
Verified: Jan 28, 2024Hawaii - Uniform Prior Authorization Form
Verified: Jan 28, 2024Minnesota - Uniform Prior Authorization Form
Verified: Jan 28, 2024New Hampshire - Uniform Prior Authorization Form
Verified: Jan 28, 2024New Mexico - Uniform Prior Authorization Form
Verified: Jan 28, 2024Texas - Uniform Prior Authorization Form
Verified: Jan 28, 2024Louisiana - Uniform Prior Authorization Form
Verified: Jan 28, 2024Arizona - Uniform Prior Authorization Form
Verified: Jan 28, 2024Indiana - Uniform Prior Authorization Form
Verified: Jan 28, 2024Illinois - Uniform Prior Authorization Form
Coverage Authorization Appeals
Patient Appeals Letter Template
Patient Appeals Letter Template - Spanish
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Benefits investigation

Referral Form: Rheumatology
Referral Form: Sarcoidosis (Pulmonology)
Referral Form: Ophthalmology
Referral Form: Nephrology
Referral Form: Multiple Sclerosis (Neurology)
Referral Form: Infantile Spasms (Neurology)
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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information
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financial assistance

Acthar financial assistance options

Co-pay savings program

commercial only
Referral Form: Rheumatology
Referral Form: Sarcoidosis (Pulmonology)
Referral Form: Ophthalmology
Referral Form: Nephrology
Referral Form: Multiple Sclerosis (Neurology)
Referral Form: Infantile Spasms (Neurology)
Enroll in Patient Savings Program
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Bridge program

commercial only
Referral Form: Rheumatology
Referral Form: Sarcoidosis (Pulmonology)
Referral Form: Ophthalmology
Referral Form: Nephrology
Referral Form: Infantile Spasms (Neurology)
Learn More

Foundation programs

under insured
no insurance
goverment insurance
65+
Acthar Patient Assistance Program
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PubMed™ | Acthar

Acthar PubMed™ News

patient education

Acthar patient education

Getting started on Acthar

Instructions For Use: All Indications
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Instructions For Use (Spanish): All Indications
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
To share resource; ask patient to:
1.Pull out phone
2.Open camera
3.Scan QR code with camera
4.Tap link

Patient toolkit

Doctor Discussion Guide: Appeals
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
RA Fact Sheet
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
SLE Fact Sheet
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
DM/PM Fact Sheet
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Sarcoidosis Fact Sheet
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Inflammatory Eye Conditions Fact Sheet
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Nephrotic Syndrome Fact Sheet
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
MS Relapse Fact Sheet
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Caregiver Brochure
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Treatment Journal Calendar
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Treatment Journal Calendar - Spanish
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Injection Tracker
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Patient Support Brochure
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Infantile Spasms Caregiver Brochure
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Infantile Spasms Injection Guide
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Infantile Spasms Treatment Tracker
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link