`` Insurance Process | Acthar® Gel (repository corticotropin injection)

Insurance process

Information and support for the insurance process.

Denise, treated with Acthar Gel.
Individual results may vary. Compensated by Keenova.

Links On this page What you can do

Acthar Patient Support will guide you through the insurance process

When your doctor prescribes Acthar Gel, Acthar Patient Support can provide information to assist you in the insurance process.
We will be there with helpful information every step of the way.

Below are simple actions you can take to help get your medicine delivered to you, if approved:

  • 1

    Answer the call from 1-888-435-2284. Your Case Manager is calling at your doctor’s request to help with your prescription.

  • 2

    Complete the Acthar Consent Form. This makes it easier for our team to help you and your doctor when working with your insurance company.

  • 3

    Share any insurance communication you get with us. We will provide information to help you navigate the insurance process and reduce out-of-pocket costs.

Your dedicated team is here to help

  • • A Case Manager will help navigate the prescription approval process
  • • A Nurse Navigator will help you understand and feel comfortable taking Acthar Gel as prescribed*

*Nurse Navigators do not provide medical advice, and patients should discuss any medical questions with their HCP.

Have a question?

Call Acthar Patient Support

1-888-435-2284

Monday – Friday, 8 AM to 9 PM ET Saturday, 9 AM to 2 PM ET

What to expect during the prescription process

You are not alone. Acthar Patient Support is by your side from the time your doctor writes your Acthar Gel prescription to when it is delivered to your door.

1
Doctor with stethoscope

Prescription

Your Case Manager at Acthar Patient Support will review your insurance coverage once your prescription is submitted.

2
Medical insurance shield

Insurance approval

If you have insurance, we will provide information to your doctor to help with the insurance process. Insurance reviews are a standard step your insurance company takes to decide if your treatment is covered. Your Case Manager will update you on the status of your approval process.

If your insurance company denies coverage for your prescription, it's normal. You have the right to appeal. Your Case Manager and Access and Reimbursement Manager (ARM) will provide information to your doctor's office about the prescription approval process. You can make a difference by writing a letter to your insurance company, and we have resources to help you do it.

3
Financial assistance checklist

Financial assistance

Regardless of your insurance status, you may qualify for financial assistance options.

Do you have commercial insurance?

You can work with your Case Manager to enroll in the Commercial Co-pay Program, if you're eligible. See Terms and Conditions.

Do you have government insurance?

Acthar Patient Support will help you understand your options for financial assistance.

Do you have limited or no insurance?

Acthar Patient Support will help you understand your options for financial assistance.

4
Delivery package

Delivery

If your prescription is approved, someone from your Specialty Pharmacy will contact you to set up delivery. Acthar Gel is shipped to your home in a refrigerated container and a signature is required for delivery. The medicine must be put in a refrigerator as soon as it is received.

Don't miss the call!

Your Specialty Pharmacy may call from toll-free numbers. Please pick up if you see a number starting with:

1-800 1-888 1-877 1-844 1-855

If you miss the call, call back as soon as possible to ensure your medicine is delivered to you.

Advocating for your care

If your prescription is denied, Acthar Patient Support can help.
It is common for insurers to reject the authorization for your prescription. If the drug is not on your insurer's policy, the insurer may need more information.

You have the right to appeal

Download resources to help understand the process and advocate for yourself.

Learn how the appeal process works and download a patient appeal letter template to help support your coverage request.

Additional resources are available to help you prepare your appeal, understand next steps, and access further support.

Download patient appeal letter templatedownload icon
left quote icon My insurance company initially denied coverage for Acthar Gel, but I didn’t feel stressed because [Acthar Patient Support] provided information directly to my doctor's office about the appeals process. I was kept informed during every step of the process.”
Dennis, treated with Acthar Gel. Individual results may vary. Compensated by Keenova.
Watch Dennis’ storyplay icon
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Learn about ways to help you afford Acthar Gel
What is Acthar Gel?
Toggle ISI tray

Acthar Gel is a prescription medicine used for:

  • Treatment for flares or on a regular basis (maintenance) in people with dermatomyositis or polymyositis (DM-PM)
  • Treatment for flares or on a regular basis (maintenance) in people with systemic lupus erythematosus (lupus)
  • Add-on therapy for short-term administration (to tide patients over an acute episode or exacerbation) in: psoriatic arthritis (PsA); rheumatoid arthritis (RA), including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy); ankylosing spondylitis
  • Treatment for people with symptomatic sarcoidosis
  • Treatment of severe acute and chronic allergic and inflammatory conditions affecting different parts of the eye. This can include the front part of the eye such as the cornea and iris, or the back part of the eye such as the optic nerve and retina
  • Reduction of proteinuria in people with nephrotic syndrome of the idiopathic type (unknown origin) without uremia (accumulation of urea in the blood due to malfunctioning kidneys) or that due to lupus erythematosus (lupus)
  • Treatment for adults with acute relapses or flares of multiple sclerosis (MS). Studies have shown Acthar to be effective in speeding recovery from an MS relapse. However, there is no evidence that it affects the ultimate outcome or natural history of the disease
  • Treatment of infantile spasms in infants and children under 2 years of age

Acthar is injected beneath the skin or into the muscle.

IMPORTANT SAFETY INFORMATION
Toggle ISI tray

DO NOT take Acthar until you have talked to your doctor if you have any of the following conditions:

  • Have been given or are about to receive a live or live attenuated vaccine
  • A skin condition called scleroderma
  • Bone density loss or osteoporosis
  • Any infections, including fungal, bacterial, or viral
  • Eye infections, such as ocular herpes simplex
  • Had recent surgery
  • Stomach ulcers or a history of stomach ulcers
  • Heart failure
  • Uncontrolled high blood pressure
  • Addison's disease or Cushing's syndrome
  • Allergies to pig-derived proteins
  • Suspected infections at birth (in infants under 2 years of age)

Tell your doctor about any other health problems that you have. Give your doctor a complete list of medicines you are taking, including all prescription and nonprescription medicines, vitamins, and herbal supplements.

What is the most important information I should know about Acthar?

  • Never inject Acthar directly into a vein
  • Acthar is injected beneath the skin or into the muscle. Always inject Acthar with SelfJect beneath the skin
  • Follow your doctor's instructions for injecting Acthar
  • Never stop treatment suddenly unless your doctor tells you to do so
  • Try not to miss any scheduled doctor's appointments. It is important for the doctor to monitor you while taking Acthar
  • You may be more likely to get new infections. Also, old infections may become active. Tell your doctor if you see any signs of an infection. Contact your doctor at the first sign of an infection or fever.
    Signs of infection are: fever, cough, vomiting, or diarrhea. Other signs may be flu or any open cuts or sores
  • When taking Acthar long-term, your adrenal gland may produce too much of a hormone called cortisol. This can result in symptoms of Cushing's syndrome. This may cause increased upper body fat, a rounded “moon” face, bruising easily, or muscle weakness
  • Sometimes when you stop taking Acthar long-term, your body may not produce enough natural cortisol. This is called "adrenal insufficiency." Your doctor may prescribe a steroid medicine to protect you until the adrenal gland recovers
  • You might develop high blood pressure, retain too much salt and water, or have low blood potassium levels. As a result of this, your doctor may recommend some changes to your diet, such as eating less salt or taking certain supplements
  • Vaccines may not work well when you are on Acthar. Talk to your doctor about which vaccines are safe to use while you are taking Acthar
  • Acthar may hide symptoms of other diseases. This can make it more difficult for your doctor to make a diagnosis of something else is going on
  • Stomach or intestinal problems. Acthar may increase the risk of bleeding and stomach ulcers. Tell your doctor if you have stomach pains, bloody vomit, bloody or black stools, excessive tiredness, increased thirst, difficulty breathing, or increased heart rate
  • Taking Acthar can make you feel irritable or depressed. You may also have mood swings or trouble sleeping. These effects are reversible once Acthar therapy is stopped
  • If you have other conditions, such as diabetes or muscle weakness, you may find they get worse
  • You might develop certain eye conditions, such as cataracts, glaucoma, or optic nerve damage
  • Your body may develop allergies to Acthar; these allergies may be severe. Signs of allergic reaction include:
    • Skin rash and itching
    • Swelling of the face, tongue, lips, or throat
    • Trouble breathing
  • The effects of Acthar may be intensified if you have an underactive thyroid or cirrhosis of the liver
  • Long-term Acthar use can affect growth and physical development in children. This can be reversed when Acthar is no longer needed
  • Acthar may cause osteoporosis (weak bones)
  • Acthar might harm an unborn baby. Therefore, tell your doctor if you are pregnant or plan to become pregnant

What are the most common side effects of Acthar?

Commonly reported side effects of Acthar include:

  • Injection site reaction
  • Fatigue, physical weakness, and lack of energy
  • Fluid retention
  • Insomnia (difficulty sleeping)
  • Headache
  • High blood sugar

The most common side effects for the treatment of infantile spasms (IS) are:

  • Increased risk of infections
  • Convulsions
  • High blood pressure
  • Irritability
  • Fever

The above side effects may also be seen in adults and children over 2 years of age. Some children with IS progress to other forms of seizures. IS sometimes makes these seizures, which may become visible after treatment for IS has been completed.

These are not all of the possible side effects of Acthar.

Tell your doctor about any side effect that bothers you, or that does not go away. Call your doctor or pharmacist for medical advice about side effects. You may report side effects to the FDA. Call 1-800-FDA-1088 or visit www.fda.gov/medwatch . You may also report side effects by calling 1-800-844-2830.

Please see the full Prescribing Information. If you've been prescribed SelfJect, please see the 40-unit or 80-unit Instructions for Use and the 40-unit or 80-unit Quick Reference Guide.

For parents and caregivers of children with infantile spasms, please also see Medication Guide.

Toggle ISI tray

What is Acthar Gel?

Acthar Gel is a prescription medicine used for:

  • Treatment for flares or on a regular basis (maintenance) in people with dermatomyositis or polymyositis (DM-PM)
  • Treatment for flares or on a regular basis (maintenance) in people with systemic lupus erythematosus (lupus)
  • Add-on therapy for short-term administration (to tide patients over an acute episode or exacerbation) in: psoriatic arthritis (PsA); rheumatoid arthritis (RA), including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy); ankylosing spondylitis
  • Treatment for people with symptomatic sarcoidosis
  • Treatment of severe acute and chronic allergic and inflammatory conditions affecting different parts of the eye. This can include the front part of the eye such as the cornea and iris, or the back part of the eye such as the optic nerve and retina
  • Reduction of proteinuria in people with nephrotic syndrome of the idiopathic type (unknown origin) without uremia (accumulation of urea in the blood due to malfunctioning kidneys) or that due to lupus erythematosus (lupus)
  • Treatment for adults with acute relapses or flares of multiple sclerosis (MS). Studies have shown Acthar to be effective in speeding recovery from an MS relapse. However, there is no evidence that it affects the ultimate outcome or natural history of the disease
  • Treatment of infantile spasms in infants and children under 2 years of age

Acthar is injected beneath the skin or into the muscle.

IMPORTANT SAFETY INFORMATION

DO NOT take Acthar until you have talked to your doctor if you have any of the following conditions:

  • Have been given or are about to receive a live or live attenuated vaccine
  • A skin condition called scleroderma
  • Bone density loss or osteoporosis
  • Any infections, including fungal, bacterial, or viral
  • Eye infections, such as ocular herpes simplex
  • Had recent surgery
  • Stomach ulcers or a history of stomach ulcers
  • Heart failure
  • Uncontrolled high blood pressure
  • Addison's disease or Cushing's syndrome
  • Allergies to pig-derived proteins
  • Suspected infections at birth (in infants under 2 years of age)

Tell your doctor about any other health problems that you have. Give your doctor a complete list of medicines you are taking, including all prescription and nonprescription medicines, vitamins, and herbal supplements.

What is the most important information I should know about Acthar?

  • Never inject Acthar directly into a vein
  • Acthar is injected beneath the skin or into the muscle. Always inject Acthar with SelfJect beneath the skin
  • Follow your doctor's instructions for injecting Acthar
  • Never stop treatment suddenly unless your doctor tells you to do so
  • Try not to miss any scheduled doctor's appointments. It is important for the doctor to monitor you while taking Acthar
  • You may be more likely to get new infections. Also, old infections may become active. Tell your doctor if you see any signs of an infection. Contact your doctor at the first sign of an infection or fever.
    Signs of infection are: fever, cough, vomiting, or diarrhea. Other signs may be flu or any open cuts or sores
  • When taking Acthar long-term, your adrenal gland may produce too much of a hormone called cortisol. This can result in symptoms of Cushing's syndrome. This may cause increased upper body fat, a rounded “moon” face, bruising easily, or muscle weakness
  • Sometimes when you stop taking Acthar long-term, your body may not produce enough natural cortisol. This is called "adrenal insufficiency." Your doctor may prescribe a steroid medicine to protect you until the adrenal gland recovers
  • You might develop high blood pressure, retain too much salt and water, or have low blood potassium levels. As a result of this, your doctor may recommend some changes to your diet, such as eating less salt or taking certain supplements
  • Vaccines may not work well when you are on Acthar. Talk to your doctor about which vaccines are safe to use while you are taking Acthar
  • Acthar may hide symptoms of other diseases. This can make it more difficult for your doctor to make a diagnosis of something else is going on
  • Stomach or intestinal problems. Acthar may increase the risk of bleeding and stomach ulcers. Tell your doctor if you have stomach pains, bloody vomit, bloody or black stools, excessive tiredness, increased thirst, difficulty breathing, or increased heart rate
  • Taking Acthar can make you feel irritable or depressed. You may also have mood swings or trouble sleeping. These effects are reversible once Acthar therapy is stopped
  • If you have other conditions, such as diabetes or muscle weakness, you may find they get worse
  • You might develop certain eye conditions, such as cataracts, glaucoma, or optic nerve damage
  • Your body may develop allergies to Acthar; these allergies may be severe. Signs of allergic reaction include:
    • Skin rash and itching
    • Swelling of the face, tongue, lips, or throat
    • Trouble breathing
  • The effects of Acthar may be intensified if you have an underactive thyroid or cirrhosis of the liver
  • Long-term Acthar use can affect growth and physical development in children. This can be reversed when Acthar is no longer needed
  • Acthar may cause osteoporosis (weak bones)
  • Acthar might harm an unborn baby. Therefore, tell your doctor if you are pregnant or plan to become pregnant

What are the most common side effects of Acthar?

Commonly reported side effects of Acthar include:

  • Injection site reaction
  • Fatigue, physical weakness, and lack of energy
  • Fluid retention
  • Insomnia (difficulty sleeping)
  • Headache
  • High blood sugar

The most common side effects for the treatment of infantile spasms (IS) are:

  • Increased risk of infections
  • Convulsions
  • High blood pressure
  • Irritability
  • Fever

The above side effects may also be seen in adults and children over 2 years of age. Some children with IS progress to other forms of seizures. IS sometimes makes these seizures, which may become visible after treatment for IS has been completed.

These are not all of the possible side effects of Acthar.

Tell your doctor about any side effect that bothers you, or that does not go away. Call your doctor or pharmacist for medical advice about side effects. You may report side effects to the FDA. Call 1-800-FDA-1088 or visit www.fda.gov/medwatch. You may also report side effects by calling 1-800-844-2830.

Please see the full Prescribing Information. If you've been prescribed SelfJect, please see the 40-unit or 80-unit Instructions for Use and the 40-unit or 80-unit Quick Reference Guide.

For parents and caregivers of children with infantile spasms, please also see Medication Guide.

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