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Acthar Gel Patient Assistance Program

Summary

Questcor Pharmaceuticals, Inc. 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.

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.

Eligibility

National Organization for Rare Disorders provides Questcor Pharmaceuticals, Inc. patient assistance program. NORD offers an one year supply of H.P. Acthar Gel at a discount of 25%-100% to those who are eligible for the program. Eligibility is based off of the following requirements:

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You must be a citizen of the United States or it's Territories.

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You must not be eligible for or covered by any private, public, or Medicare Part D prescription coverage programs.

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You must be financially unable to afford Acthar.

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You must be diagnosed with one of the following conditions: Infantile spasms, multiple sclerosis, Crohns disease, Adrenal insufficiency, etc.

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

SOURCE: 2008 Poverty Chart

Family Size	100%	133%	150%	200%	250%	300%
1	$10,830	$14,404	$16,245	$21,660	$27,075	$32,490
2	$14,570	$19,378	$21,855	$29,140	$36,425	$43,710
3	$18,310	$24,352	$27,465	$36,620	$45,775	$54,930
4	$22,050	$29,327	$33,075	$44,100	$55,125	$66,150
5	$25,790	$34,301	$38,685	$51,580	$64,475	$77,370
6	$29,530	$39,275	$44,295	$59,060	$73,825	$88,590
7	$33,270	$44,249	$49,905	$66,540	$83,175	$99,810
8	$37,010	$49,223	$55,515	$74,020	$92,525	$111,030
For each additional family member	$3,740	$4,974	$5,610	$7,480	$9,350	$11,220

What´s Next?

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.

Other Tips

If you have any questions please call the Questcor Pharmaceuticals program directly
Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in
Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don’t run out of medication.
Do not write messy on your forms as this will delay any response
Call and write thank you notes to Questcor Pharmaceuticals program. Without their help millions of people will be without medication.

PAP Links:

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List of Medications

Acthar Gel (corticotropin (acth))

Forms and other information are Copyright © Acthar Gel Patient Assistance Program

While you are waiting to qualify for your free medication please try a Free Discount Drug Card > Click Here

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