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Visit ActharConsent.com to complete the form
You were recently prescribed Acthar® Gel (repository corticotropin injection) by your doctor. In order for Acthar Patient Support to give you our complete level of support during the insurance approval process—and to help with getting your prescription delivered to you—we kindly request that you visit ActharConsent.com and complete the Patient Information section. When you’re done, the Acthar Consent Form will be sent to us electronically.
After we receive the Acthar Consent Form, we will call you so we can help you try to get your medicine. Please be on the lookout for our call and answer calls from 1-800 numbers.
If you have any questions or need any help with the form, please give us a call. We are here to help you!
Acthar Patient Support is available at 1-888-435-2284
Monday through Friday, 8 AM to 9 PM ET
Saturday, 9 AM to 2 PM ET
Visit us online at Acthar.com.
Thank you!
Your Acthar Patient Support Team
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