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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:


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


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


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 May 01, 2018