When Acthar Gel Isn't Available, You Still Have Options

Acthar Gel (repository corticotropin injection) is a powerful medication for some of the most challenging autoimmune and inflammatory conditions. But with a price tag exceeding $45,000 per vial, specialty-pharmacy-only distribution, and complex insurance requirements, many patients find themselves unable to fill their prescription — at least not right away.

If you're in that situation, don't panic. There are real alternatives worth discussing with your doctor. The right option depends on your specific condition, treatment history, and what your body has responded to before.

What Is Acthar Gel and How Does It Work?

Acthar Gel is a naturally sourced injectable medication containing adrenocorticotropic hormone (ACTH) analogs and other pituitary peptides. It's manufactured by Mallinckrodt Pharmaceuticals and has been on the market since the 1950s.

It works through two mechanisms:

1. Adrenal stimulation: Acthar Gel stimulates your adrenal glands to produce cortisol and other corticosteroids, reducing inflammation
2. Melanocortin receptor activation: It binds directly to melanocortin receptors (MCRs) on immune cells, which may provide additional anti-inflammatory and immunomodulatory effects beyond what standard corticosteroids offer

This dual mechanism is what makes Acthar Gel unique — and what makes finding a true equivalent challenging. For a deeper dive, read our article on how Acthar Gel works.

Acthar Gel is FDA-approved for conditions including infantile spasms, multiple sclerosis relapses, nephrotic syndrome, rheumatoid arthritis, lupus, dermatomyositis/polymyositis, sarcoidosis, and several ophthalmic inflammatory diseases.

Alternative 1: Purified Cortrophin Gel

What it is: Purified Cortrophin Gel (repository corticotropin injection USP) is another ACTH-based injectable medication. It was FDA-approved in 2021 and is manufactured by ANI Pharmaceuticals.

How it compares:

• Same drug class as Acthar Gel (ACTH/corticotropin)
• Approved for most of the same indications: MS relapses, rheumatic disorders, lupus, dermatomyositis/polymyositis, nephrotic syndrome, sarcoidosis, and ophthalmic inflammatory conditions
• Not approved for infantile spasms — this is a critical difference for pediatric patients
• Approximately 23% less expensive than Acthar Gel (WAC price ~$6,961/mL vs. Acthar's ~$9,061/mL)

Who it's for: Adult patients who need ACTH therapy and can't access Acthar Gel. It's the closest alternative in terms of mechanism of action.

Important note: Like Acthar Gel, Cortrophin Gel requires specialty pharmacy distribution and typically needs prior authorization. It's not necessarily easier to find, but it does provide another option in the ACTH class.

Alternative 2: High-Dose Corticosteroids

What they are: Corticosteroids like IV methylprednisolone (Solu-Medrol) and oral prednisone are the most commonly used anti-inflammatory medications and are typically the first-line treatment for many conditions that Acthar Gel treats.

How they compare:

• Much more widely available — stocked at virtually every pharmacy
• Dramatically less expensive (generic prednisone costs a few dollars; IV methylprednisolone is also relatively affordable)
• Well-established efficacy for MS relapses, lupus flares, nephrotic syndrome, and inflammatory conditions
• Do not activate melanocortin receptors — they work solely through glucocorticoid pathways
• Long-term use carries significant side effects: weight gain, bone loss, diabetes, cataracts, and adrenal suppression

Who they're for: Patients who haven't yet tried high-dose corticosteroids (most insurers require this as step therapy before approving Acthar Gel), or patients who need immediate treatment while waiting for Acthar Gel authorization.

Alternative 3: Rituximab (Rituxan)

What it is: Rituximab is a biologic medication that targets CD20-positive B cells. It's used for several of the same autoimmune conditions that Acthar Gel treats.

How it compares:

• Different mechanism — destroys B cells rather than stimulating cortisol production or activating melanocortin receptors
• FDA-approved for rheumatoid arthritis and certain types of vasculitis; used off-label for lupus nephritis, nephrotic syndrome, and MS
• Given as an IV infusion, typically in a clinic or infusion center
• Biosimilar versions are available, which may reduce cost

Who it's for: Patients with lupus nephritis, nephrotic syndrome, or RA who haven't responded to corticosteroids and need a different immunosuppressive approach.

Alternative 4: Mycophenolate Mofetil (CellCept)

What it is: Mycophenolate mofetil is an oral immunosuppressant that inhibits T and B lymphocyte proliferation. It's widely used in transplant medicine and autoimmune diseases.

How it compares:

• Oral medication — no injections required
• Much less expensive than Acthar Gel (generic available for under $100/month)
• Commonly used for lupus nephritis and nephrotic syndrome
• Slower onset of action compared to ACTH therapy or corticosteroids
• Carries its own side effect profile including GI issues, increased infection risk, and blood count abnormalities

Who it's for: Patients with lupus nephritis or nephrotic syndrome who need long-term immunosuppression and can't access or tolerate ACTH therapy.

How to Decide Which Alternative Is Right for You

This is a conversation to have with your doctor. Key factors include:

• Your diagnosis: Some alternatives work better for certain conditions. For infantile spasms, there is no true equivalent to Acthar Gel — high-dose vigabatrin is the main alternative.
• What you've already tried: If you've failed corticosteroids, your doctor may lean toward Cortrophin Gel or rituximab rather than another steroid course.
• Speed of onset: For acute flares (MS relapses, lupus flares), you need something fast-acting. IV methylprednisolone works within days. Mycophenolate takes weeks.
• Insurance coverage: Some alternatives may be easier to get approved by your insurer.
• Side effect tolerance: Each option has a different risk profile. Discuss what matters most to you.

Don't Give Up on Finding Acthar Gel

While exploring alternatives, it's worth continuing to pursue Acthar Gel if that's what your doctor recommends. Tools like Medfinder can help you locate specialty pharmacies with current supply. Read our guide on how to find Acthar Gel in stock near you for practical strategies.

You can also call Acthar Patient Support at 1-888-435-2284 for help with insurance navigation and specialty pharmacy connections.

Final Thoughts

Not being able to fill an Acthar Gel prescription is stressful, especially when you're dealing with a serious health condition. But there are real alternatives available. Purified Cortrophin Gel is the closest substitute in the ACTH class, while high-dose corticosteroids, rituximab, and mycophenolate offer different approaches depending on your condition.

Talk to your doctor, explore your options, and use resources like Medfinder to keep searching for the medication that works best for you.