Patient-Helpdesk.com

acthar patient assistance form

by Fermin Goodwin Published 2 years ago Updated 1 year ago
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What is the Acthar gel Prescription Assistance Program?

The program provides up to $15,000 per calendar year toward the patient’s Acthar Gel prescription costs. Eligibility: Available to patients with commercial prescription insurance coverage for Acthar Gel.

How do I stop using the Acthar gel copay card?

If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the Acthar Gel Copay Card and patient must call Acthar Patient Support at 1-888-435-2284 to stop participation.

How can Acthar Patient Support Help Me?

Your Case Manager can better help you understand your options and connect you with the appropriate resources. If you have government insurance, Acthar Patient Support will help you understand your options for financial assistance. Learning how to take or give Acthar Gel is personal.

How can I learn how to take Acthar gel?

Learning how to take or give Acthar Gel is personal. That’s why Acthar Patient Support offers free Acthar Gel injection training that’s based on your level of need. While your prescription is in the approval process, we’ll contact you to discuss your training needs and how best to accomplish them—in your home, online, or by phone.

How does Acthar work?

Who delivers Acthar gel?

How to contact a nurse navigator?

Can Acthar Gel be denied?

Does Acthar Gel have patient support?

Is Acthar Gel a referral?

Does the actual patient compensate for his time?

See 2 more

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How can I get acthar?

Your doctor prescribes Acthar Gel for you. Your doctor's office then submits your prescription to Acthar Patient Support. Once the prescription is submitted by your doctor, Acthar Patient Support will review your insurance coverage.

How much does acthar cost?

The cost for H.P. Acthar Gel injectable solution (80 units/mL) is around $40,613 for a supply of 5 milliliters, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

How long does acthar take to work?

The new ACTRIMS data suggest that it can lead to “significant improvements after two months of use” for those who experience stubborn flares that fail to respond to high-dose corticosteroid treatments. These improvements were shown to last for at least six months.

What is acthar used for?

Acthar® Gel is a prescription medicine used for: Treatment for flares or on a regular basis (maintenance) in people with dermatomyositis or polymyositis (DM-PM) Treatment for flares or on a regular basis (maintenance) in people with systemic lupus erythematosus (lupus)

Does Medicare pay for Acthar?

Do Medicare prescription drug plans cover Acthar Gel? No. In general, Medicare prescription drug plans (Part D) do not cover this drug.

How much does a vial of ACTH cost?

Today, however, a typical vial of Acthar is priced at $39,864-—approximately 140,000% more expensive than when it was approved 68 years ago. Acthar is one of the 20 most expensive medications in the United States. In 2014, Mallinckrodt acquired Questcor Pharmaceuticals, which owned the rights to Acthar.

What happens when ACTH is low?

A decline in the concentration of ACTH in the blood leads to a reduction in the secretion of adrenal hormones, resulting in adrenal insufficiency (hypoadrenalism). Adrenal insufficiency leads to weight loss, lack of appetite (anorexia), weakness, nausea, vomiting, and low blood pressure (hypotension).

What are the side effects of acthar?

Common side effects may include:increased blood pressure;thinning skin, increased sweating;fluid retention (swelling in your hands or feet, puffiness in your face);mood changes, irritability;increased appetite; or.weight gain.

Is acthar a steroid?

Acthar Gel is not a steroid.

How often is acthar given?

Recommended dosing from the label Acthar Gel offers flexible dosing, with a recommended 40-80 units every 1-3 days across multiple indications.

What drug class is acthar?

H.P. Acthar Gel is a prescription medicine used to treat the symptoms of Nephrotic Syndrome, Acute Exacerbations of Multiple Sclerosis and Verification of Adrenal Responsiveness. H.P. Acthar Gel may be used alone or with other medications. H.P. Acthar Gel belongs to a class of drugs called Corticosteroids.

Does acthar Gel cause weight gain?

High blood pressure, changes in heart and kidney function Acthar Gel (corticotropin) can cause high blood pressure, unexplained weight gain, and other changes in the way your kidneys work.

How often is acthar given?

Recommended dosing from the label Acthar Gel offers flexible dosing, with a recommended 40-80 units every 1-3 days across multiple indications.

Does acthar gel work?

Studies have shown Acthar to be effective in speeding recovery from an MS relapse. However, there is no evidence that it affects the ultimate outcome or natural history of the disease. Treatment of infantile spasms in infants and children under 2 years of age.

Is acthar an orphan drug?

According to the documents obtained and released by the House Oversight Committee in a broad probe of drug pricing practices, Mallinckrodt targeted Questcor primarily because of Acthar, a so-called orphan drug that helps 2,500 kids a year in the U.S. afflicted by infantile spasms.

What is acthar made from?

Acthar contains a highly purified preparation of the hormone adrenocorticotropin (also referred to as ACTH) in gelatin. This preparation is injected either into the muscle (intramuscularly) or under the skin (subcutaneously).

Can you enroll in Acthar Gel over the phone?

Enrollment over the phone during the Acthar Gel welcome call or anytime you speak with your Case Manager

Does Mallinckrodt provide Acthar Gel?

Mallinckrodt provides Acthar Gel at no cost to eligible patients with a valid, on-label prescription for Acthar Gel who have no insurance, are underinsured, or are rendered uninsured

What is Acthar patient support?

Acthar Patient Support is dedicated to helping patients who are prescribed Acthar Gel get the treatment they need.

How to contact Acthar Gel?

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

Can Mallinckrodt revoke copay?

Mallinckrodt reserves the right to rescind, revoke, or amend the co-pay assistance program at any time without notice.

Does Acthar provide copay assistance?

Enrollment in the co-pay assistance program does not guarantee assistance. Whether an expense is eligible for the co-pay benefit will be determined at the time the benefit is paid. Eligible co-pay expenses must be in connection with a separately paid claim for Acthar®Gel which is otherwise covered by a private/commercial insurance plan.

Does Acthar Gel cover out of pocket costs?

The program covers out-of-pocket costs for Acthar®Gel only. The program will not and shall not be applied toward the cost of any other product, healthcare provider service, supply charges or other treatment costs.

Do you need a prescription for Acthar?

Patient must have a valid Acthar®Gel prescription for an FDA-approved, on-label indication.

Can you enroll in Acthar Gel over the phone?

Enrollment over the phone during the Acthar Gel welcome call or any time they are speaking with their Case Manager

What is Acthar referral form?

The Acthar Referral Form Guideincludes easy-to-follow instructions for completing an Acthar Referral Form, including recommended dosing information, patient authorization, and scheduling injection training.

What is page 3 of Acthar?

When a patient signs page 3 of the Acthar Referral Form, they enable our complete level of support by authorizing Acthar Patient Support to interact with some pharmacies and insurance providers on their behalf.

What is a prescription helper?

Helping process prescriptions with the insurance provider

What is a patient support?

Providing support for patients throughout their treatment journey

How to contact ARM?

Simply call 1-888-435-22841-888-435-2284and request a visit from your local Access and Reimbursement Manager (ARM) to learn how our dedicated team members:

When was Acthar Gel first used?

H.P. Acthar Gel was launched by Questcor Pharmaceuticals, Inc. in 2005. It has been approved by the FDA for use in treament of acute exacerbations of multiple sclerosis. H.P. Acthar Gel is available in gel form and does not require a physician to administer.

How to enroll in Questcor?

Fill out the program enrollment form located to your right. If you don't see an enrollment form available please call Questcor Pharmaceuticals program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

Where do you send medication to?

The medication must be sent to the Hospital, Physicians Office, or Pharmacy.

What is Questcor Pharmaceuticals?

is a California based pharmaceutical company started in 1990 that focuses specifically on developing products for central nervous system disorders. Originally Questcor Pharmaceuticals, Inc. offered a much wider selection of products, but as they shifted their focus soley to central nervous system related developments, that had to part ways with several products.

What is Acthar?

H.P. Acthar Gel, commonly known as Acthar, is a prescription medication that is FDA approved for the treatment of multiple conditions, including symptoms of sarcoidosis, and has been used for many years

How is Acthar administered?

Acthar is an injection that can be given preferably subcutaneously (beneath the skin)or intramuscularly (into the muscle)

Meet Kerry, an Acthar Patient

Learn about Kerry’s experience living with sarcoidosis and how Acthar helped to manage her symptoms.

Important Safety Information

DO NOT take Acthar until you have talked to your doctor if you have any of the following conditions:

What is Mallinckrodt patient assistance?from patientassistance.com

Mallinckrodt Patient Assistance Program is a patient assistance program provided by Mallinckrodt which offers the medications listed to the right at a discount to those who are eligible for the program. The prescription lasts for month for twelve months, at which point the patient must complete there-application process. Eligibility is based off of the following requirements:

How to enroll in Mallinckrodt?from patientassistance.com

Fill out the program enrollment form located to your right. If you don't see an enrollment form available please call Mallinckrodt program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

What are the requirements for Medicare Part D?from patientassistance.com

Eligibility is based off of the following requirements : - You must not be covered by private or public health insurance. - You must meet an undisclosed income guideline. - You are responsible for a $20 co-pay. - Those eligible for Medicare Part D, however are not currently enrolled may be eligible, and should apply.

What is Genentech Patient Foundation?

The Genentech Patient Foundation gives free Genentech medicine to people who don't have insurance or who have financial concerns and meet eligibility criteria. Two forms are needed to enroll in the Genentech Patient Foundation:

Is Actemra a RSVP?

ACTEMRA ® (tocilizumab) patients enrolled in ACTEMRA Access Solutions are automatically enrolled in RSVP. Use this form to opt out of this program.

How does Acthar work?

A prior authorization is a way insurance companies make sure that the medicine your doctor prescribed is needed for your condition. Acthar Patient Support will collect the required paperwork from your doctor and submit the information to your insurance company— you don’t have to manage the process. Your Case Manager will provide you with updates on the status of your approval process so you know what’s going on every step of the way.

Who delivers Acthar gel?

Acthar Gel is delivered by your Specialty Pharmacy. Acthar Patient Support works with your Specialty Pharmacy to begin the delivery process so you don’t have to. After approval, someone from your Specialty Pharmacy will contact you to set up your delivery of Acthar Gel.

How to contact a nurse navigator?

Your Nurse Navigator will be happy to assist. Call 1-888-435-2284

Can Acthar Gel be denied?

While Acthar Gel may be denied for insurance coverage for any number of reasons, it’s common to feel upset or frustrated. However, you can appeal this decision by the insurance company and there are many ways to approach an appeal. Acthar Patient Support can help you with the appeals process.

Does Acthar Gel have patient support?

From the time your doctor writes your prescription for Acthar Gel to the time the medicine is delivered to your doorstep, Acthar Patient Support is by your side every step of the way.

Is Acthar Gel a referral?

You are automatically enrolled in Acthar Patient Support when your doctor submits your referral (prescription). A dedicated team, including a Nurse Navigator and a Case Manager, is ready to help you understand treatment with Acthar Gel, review your insurance options, help you get the medicine your doctor has prescribed, and offer support as you start and continue your treatment plan.

Does the actual patient compensate for his time?

Individual results may vary. Actual patient compensated for his time.

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