Acthar Gel is available through independent, in-network specialty pharmacy distribution. Patients cannot get their Acthar Gel prescription filled at most retail pharmacies.* Get your patients off to a good start by completing the Acthar Referral Form and faxing it to the Acthar Patient Support Team at 1-877-937-2284.

*CVS and Walgreens can arrange prescription pickup at their locations but require some advance notice to ensure medication is available at a local pharmacy.

When filling out the Acthar Referral Form, follow these guidelines to help expedite initiation with insurance companies:

  • Be sure to include phone numbers for both the direct office contact and backup office contact
  • Provide clinical documentation and copies of detailed patient charts/notes
  • Since prior authorizations and appeals are common, a Letter of Medical Necessity may be needed

Appeals

If the referral is denied, you may have the option to appeal to the patient’s plan with the support of the Acthar Patient Support Team.

If your office receives a denial letter or any correspondence from the insurance company, fax it to the Acthar Patient Support Team immediately. Having all relevant insurance company communications helps the Case Manager better support the reimbursement process.

If the appeal process is unsuccessful, patients will be referred to the Acthar Patient Assistance Program to determine eligibility about receiving Acthar Gel at no cost.

For questions about the Acthar Gel referral process or the status of an existing referral, please call the Acthar Patient Support Team at 1-888-435-2284 Monday through Friday from 8 AM to 9 PM ET, and Saturday from 9 AM to 2 PM ET.

Program administered via a third-party organization.

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.