Terms and Conditions:

• The Acthar Commercial Co-pay Program provides drug co-pay assistance of up to $25,000 per calendar year for eligible patients
• This program is valid for eligible, privately and commercially insured patients. For more details about the eligibility criteria, see below
• This program is not valid for prescriptions for which payment may be made in whole or in part under federal or state health programs, including but not limited to Medicare or Medicaid
• This program is not valid for uninsured patients
• Program offer is limited to one membership per person and is not transferrable
• Patients should consult their insurance provider concerning any limitations that may apply to this program under their insurance policy
• The program does not represent prescription drug coverage or insurance and is not intended to substitute for such coverage
• Patients are responsible for any co-payment or coinsurance costs above and beyond the program’s annual maximum benefit
• Void where prohibited by law
• Not valid outside the United States
• Mallinckrodt ARD, Inc. reserves the right to terminate or modify this program at any time without notice

Eligibility Criteria:

• Approved indication
• US permanent resident
• Patient (or patient’s legal representative) must be 18 years of age or older to opt in to program
• Commercially or privately insured
• Not insured by a federal or state healthcare plan or where prohibited by law