Acthar is only available through a specialty pharmacy, so it is common for the prescription process to involve multiple steps, starting with your completion of the Physician Referral/Prescription Form and submission to A.S.A.P.

Your prompt attention to these items can help expedite the process:

  • Include phone numbers for your direct office contact and a backup office contact
  • Provide clinical documentation along with detailed patient charts and notes
  • Be prepared to make a statement of medical necessity if a prior authorization is required

Appeals

A.S.A.P. will help facilitate the appeals process if a referral is denied. If you receive a denial letter or any correspondence directly from the payer, fax it to A.S.A.P. immediately.

If the appeals process is unsuccessful, qualified patients will be referred to the Mallinckrodt Patient Assistance Program (which is administered by a third-party organization) to receive Acthar at no cost.

If you have any questions about the Acthar referral process or the status of an existing referral, please call A.S.A.P. at 1-888-435-2284. Support specialists are available Monday through Friday, from 8 AM to 8 PM ET and 9 AM to 2 PM ET on Saturday.

Helpful Resources

Request a rep visit

Contact your Acthar sales specialist.

Physician Referral/Prescription Form

Download for your practice to complete.

Caregiver Injection Training and Starter Kit

Information about Infantile Spasms and how to inject Acthar.