YOUR GUIDE TO PATIENT SUPPORT H.P. Acthar Gel (repository corticotropin injection) is indicated for the reduction of proteinuria in people with nephrotic syndrome of the idiopathic type (unknown origin) without uremia (accumulation of urea in the blood due to malfunctioning kidneys) or that due to lupus erythematosus (lupus). Please see Important Safety Information inside, and the accompanying full Prescribing Information.
Your no-cost options for patient support The distributor of Acthar offers 3 different support services at no cost to you. You can get help with insurance coverage or financial assistance, receive one-on-one injection training from a registered nurse in the convenience of your home, and sign up for ongoing support from a nurse coach. Financial assistance for Acthar 1-888-435-2284 Acthar.com Your Acthar prescription is automatically processed through A.S.A.P. (Acthar Support & Access Program). A.S.A.P. is a no-cost program that helps you get all the important information about cost, coverage, and home delivery. A.S.A.P. helps make Acthar affordable for patients by identifying sources of financial assistance including: $0 copay for eligible patients with commercial or private insurance* Acthar offered at no cost for eligible uninsured and underinsured patients Other sources of financial assistance, such as additional copay assistance, for qualified patients in need who do not meet requirements for the above programs One-on-one home injection training 1-888-435-2284 Acthar.com At no cost to you, Acthar Home Injection Training Services (Acthar HITS) can schedule a registered nurse to visit you at your home to provide you or your caregiver training on how to administer Acthar If you have any questions about administration, the nurse is there to answer them ACTHAR H.I.T.S. Ongoing support from a registered nurse 1-888-419-8482 ActharPACT.com The Patient & Acthar Coaching Team (ActharPACT) provides personalized support from a registered nurse trained to answer your questions about kidney disease, proteinuria, and Acthar treatment at no cost to you As part of the program, you can schedule calls with your nurse coach at a time and frequency best for you throughout the course of treatment Phone coaching services are available in over 20 languages You also have the option to schedule personalized text, email, mail, or online follow-up support and education as frequently or infrequently as you request, with the ability to cancel service at any time * Up to a maximum copay benefit of $25,000 per person is available per calendar year. This program is not for patients receiving prescription reimbursement under any federal-, state-, or government-funded insurance programs or where prohibited by law. Additional terms and conditions and eligibility criteria apply. Program administered via third-party organization. Program administered via an independent charitable organization. Phone translation services available for all languages may vary for unscheduled calls. To ensure availability, it is best to request the service when enrolling.
Acthar support from start to finish* Getting Started 1 2 3 4 5 6 ActharPACT For a nurse coach and personalized support Whenever you have questions along the way A.S.A.P. For financial support Whenever you have questions about refill coverage I feel like I have a handle on things with all of this support. Specialty Pharmacy For monthly follow-up calls to arrange Acthar refills Acthar HITS For help with the first injection *Based on a 6-month course of therapy.
Patient support starts when your doctor prescribes Acthar and continues throughout your treatment Here s what you can expect: Getting started My doctor prescribed Acthar. Now what? A.S.A.P. specialists will contact you to help you navigate the process of getting started and will work with your insurance company to help try to secure the best coverage at the lowest possible copay ActharPACT nurse coaches will also be available to address any of your questions or concerns about Acthar At the time of your first Acthar prescription and each refill, you may receive calls from A.S.A.P. or the Specialty Pharmacy to make sure your needs are met Even if caller ID lists the number as unknown or blocked, it may be a call about Acthar support Choosing support TIPS: Call A.S.A.P. if you have any questions about Acthar cost or coverage Call A.S.A.P. or ask your doctor to check the HITS box on your referral form to enroll in injection training Decide when and how often your ActharPACT nurse coach should call and what support you need I m ready to start therapy. What happens next? If you need help learning to give yourself the first injection, a registered nurse can visit your home to provide you or your caregiver training on how to administer Acthar If you would like to receive personalized support from a nurse coach, your doctor can enroll you in ActharPACT, or you can set up this no-cost service by calling 1-888-419-8482, by submitting the enrollment card found in your Starter Kit, or by visiting ActharPACT.com Continuing treatment What if I have questions along the way? It s very important to follow Acthar treatment as prescribed and to take Acthar for as long as your doctor recommends. Once enrolled, you can always call ActharPACT with questions you may have or if any treatment challenges come up If you are running low on Acthar and the Specialty Pharmacy hasn t called or confirmed your refill, call 1-888-435-2284 right away Keep this card with you for quick access to Acthar support. For financial assistance, delivery details, and injection training: 1-888-435-2284 Acthar.com To talk with a registered nurse at your convenience: 1-888-419-8482 ActharPACT.com
Important Safety Information Acthar is injected beneath the skin or into the muscle. It should never be injected into a vein. You should not take Acthar if you have: a skin condition called scleroderma, bone density loss, any infections, herpes simplex of the eye, had recent surgery, stomach ulcers or history of ulcers, heart problems, high blood pressure or allergies to pig-derived protein. Tell your doctor if you are pregnant or plan on becoming pregnant. While taking Acthar, tell your doctor if you have any of these symptoms: infections; adrenal gland changes, which may cause symptoms of Cushing s syndrome, such as upper body fat, rounded moon face, bruising easily, or muscle weakness; increased blood pressure, body salt, and fluid; unpredictable response to vaccines; stomach or intestinal problems; changes in mood or behavior; worsening of other medical conditions; eye problems; or allergic reactions. Tell your doctor about any health problems or any other medicines you are taking. Acthar can cause side effects similar to those with steroid treatments. Taking Acthar may mask symptoms of other diseases and may cause bone density loss at any age. The most common side effects include: fluid retention, changes in blood sugar, increased blood pressure, behavior and mood changes, and changes in appetite and weight. Specific side effects in children under 2 years of age include: increased risk of infections, increased blood pressure, irritability, symptoms of Cushing s syndrome, cardiac hypertrophy (thickening of the heart muscle) and weight gain. The above side effects may also be seen in adults and children over 2 years of age. These are not all of the possible side effects of Acthar. Tell your doctor about any side effect that bothers you, or that does not go away. Call your doctor or pharmacist for medical advice about side effects. You may report side effects to the FDA. Call 1-800-FDA-1088 or visit fda.gov/medwatch. You may also report side effects by calling 1-800-778-7898. Please see the full Important Safety Information for patients at Acthar.com. For full Prescribing Information, please visit Acthar.com/HCP/PrescribingInformation. Your doctor is your primary source of information on your treatment. Talk to your doctor if you have any questions about your treatment or condition. Keep this card with you for quick access to Acthar support.
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