How to Get Acthar for Your Patients

Getting started is simple

Step 1

Step_1

Complete the Acthar Start Form and fax it to the Acthar Hub at 1-877-937-22841-877-937-2284.

Step 2

Step_2

The Acthar Hub faxes back a confirmation and contacts the office within 4 business hours to explain next steps, including prior authorization requirements.

Step 3

Step_3

The Acthar Hub may contact the office staff with questions. Responding in a timely manner helps ensure patients get access to Acthar as soon as possible.

If you have any questions, contact the Acthar Hub:

Phone: 1-888-435-22841-888-435-2284

Fax: 1-877-937-22841-877-937-2284

The Case Manager at the Acthar Hub will keep office staff and patients informed about the status of their prescription.

Physician referrals

Acthar is available through independent, in-network Specialty Pharmacy distribution. Patients cannot get their Acthar prescription filled at most retail pharmacies.*

When filling out the Acthar Start Form, following these guidelines will help maximize success 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

If the referral is denied, you may have the option to appeal to the patient's plan with the support of the Acthar Hub.

  • If your office receives a denial letter or any correspondence from the insurance company, fax it to the Acthar Hub 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 at
    no cost

For questions about the Acthar referral process or the status of an existing referral, please call the Acthar Hub at 1-888-435-22841-888-435-2284 Monday through Friday from
8 AM to 9 PM ET, and Saturday from 9 AM to 2 PM ET.

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

Program administered via a third-party organization.

Physician referrals

Acthar is available through independent, in-network Specialty Pharmacy distribution. Patients cannot get their Acthar prescription filled at most retail pharmacies.*

When filling out the Acthar Start Form, following these guidelines will help maximize success 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

If the referral is denied, you may have the option to appeal to the patient's plan with the support of the Acthar Hub.

  • If your office receives a denial letter or any correspondence from the insurance company, fax it to the Acthar Hub 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 at
    no cost

For questions about the Acthar referral process or the status of an existing referral, please call the Acthar Hub at 1-888-435-22841-888-435-2284 Monday through Friday from
8 AM to 9 PM ET, and Saturday from 9 AM to 2 PM ET.

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

Program administered via a third-party organization.

Important Safety Information

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Contraindications

  • Acthar should never be administered intravenously
  • Administration of live or live attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of Acthar
  • Acthar is contraindicated where congenital infections are suspected in infants

Important Safety Information

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Contraindications

  • Acthar should never be administered intravenously
  • Administration of live or live attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of Acthar
  • Acthar is contraindicated where congenital infections are suspected in infants
  • Acthar is contraindicated in patients with scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, recent surgery, history of or the presence of a peptic ulcer, congestive heart failure, uncontrolled hypertension, primary adrenocortical insufficiency, adrenocortical hyperfunction or sensitivity to proteins of porcine origins

Warnings and Precautions

  • The adverse effects of Acthar are related primarily to its steroidogenic effects
  • Acthar may increase susceptibility to new infection or reactivation of latent infections
  • Suppression of the hypothalamic-pituitary-axis (HPA) may occur following prolonged therapy with the potential for adrenal insufficiency after withdrawal of the medication. Adrenal insufficiency may be minimized by tapering of the dose when discontinuing treatment. During recovery of the adrenal gland patients should be protected from the stress (e.g. trauma or surgery) by the use of corticosteroids. Monitor patients for effects of HPA suppression after stopping treatment
  • Cushing’s syndrome may occur during therapy but generally resolves after therapy is stopped. Monitor patients for signs and symptoms
  • Acthar can cause elevation of blood pressure, salt and water retention, and hypokalemia. Blood pressure, sodium and potassium levels may need to be monitored
  • Acthar often acts by masking symptoms of other diseases/disorders. Monitor patients carefully during and for a period following discontinuation of therapy
  • Acthar can cause GI bleeding and gastric ulcer. There is also an increased risk for perforation in patients with certain gastrointestinal disorders. Monitor for signs of bleeding
  • Acthar may be associated with central nervous system effects ranging from euphoria, insomnia, irritability, mood swings, personality changes, and severe depression, and psychosis. Existing conditions may be aggravated
  • Patients with comorbid disease may have that disease worsened. Caution should be used when prescribing Acthar in patients with diabetes and myasthenia gravis
  • Prolonged use of Acthar may produce cataracts, glaucoma and secondary ocular infections. Monitor for signs and symptoms
  • Acthar is immunogenic and prolonged administration of Acthar may increase the risk of hypersensitivity reactions. Neutralizing antibodies with chronic administration may lead to loss of endogenous ACTH activity
  • There is an enhanced effect in patients with hypothyroidism and in those with cirrhosis of the liver
  • Long-term use may have negative effects on growth and physical development in children. Monitor pediatric patients
  • Decrease in bone density may occur. Bone density should be monitored for patients on long-term therapy
  • Pregnancy Class C: Acthar has been shown to have an embryocidal effect and should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus

Adverse Reactions

  • Common adverse reactions for Acthar are similar to those of corticosteroids and include fluid retention, alteration in glucose tolerance, elevation in blood pressure, behavioral and mood changes, increased appetite and weight gain
  • Specific adverse reactions reported in IS clinical trials in infants and children under 2 years of age included: infection, hypertension, irritability, Cushingoid symptoms, constipation, diarrhea, vomiting, pyrexia, weight gain, increased appetite, decreased appetite, nasal congestion, acne, rash, and cardiac hypertrophy. Convulsions were also reported, but these may actually be occurring because some IS patients progress to other forms of seizures and IS sometimes mask other seizures, which become visible once the clinical spasms from IS resolve

Other adverse events reported are included in the full Prescribing Information.

Please see full Prescribing Information.

Indication

H.P. Acthar® Gel (repository corticotropin injection) is indicated for severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as: keratitis, iritis, iridocyclitis, diffuse posterior uveitis and choroiditis, optic neuritis, chorioretinitis, anterior segment inflammation.

References