Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Acthar Support & Access Program (A.S.A.P)

This program provides brand name medications at no or low cost

Provided by: Mallinckrodt Pharmaceuticals


TEL: 888-435-2284


FAX: 877-937-2284
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Acthar Support & Access Program (A.S.A.P): Contact program

 

Brand Name Medications Covered

 
  • H.P. Acthar Gel
 

Generic Name

 
  • repository corticotropin
 

Eligibility Requirements   

Insurance Status *Contact program for details.
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Varies
US Residency Required? Yes, and must be treated by US doctor
   

Application

Obtaining Doctor/Doctor's office must call or download
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 2-3 days
   

Medication

Amount/Supply Varies
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information



Updated June 07, 2017