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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Questcor Pharmaceuticals |
| Program Name |
Acthar Gel Patient Assistance Program |
| Program Address |
C/O NORD
PO Box 1968
Danbury, CT 06813-1968 |
| Phone Number |
888-435-2284
|
| Fax Number |
203-798-2289 |
| Medications on Program |
Acthar Gel (corticotropin (acth))
|
| Application Forms |
Not Applicable |
On-line Application
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No on-line application available at this time |
| Web Site |
No link available. |
| Eligibility Guidelines and Notes |
The patient must have no insurance and be financially unable to afford the medication. The patient is given assistance from 25%-100% for one year. A negative decision can be appealed. The patient must also be a US citizen being treated by a US doctor.
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| Application Process |
With the patient's permission, anyone concerned can call for an application. The application is sent to the patient. The completed application can be faxed or mailed back.
The estimated timeline is 3-5 business days.
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| Application Requirements |
The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section, sign the application, and attach proof of income and any denial letters from insurance companies.
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| Program Details |
The medication is sent to the patient's home, doctor's office, hospital or pharmacy. Once a year a new application with financial documentation is needed.
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| Last Updated |
November 13, 2009 |
