Cortrophin Gel vs. Acthar Gel: Cost, Indications & Copay Assistance Guide

>When a patient is prescribed repository corticotropin injection — commonly known as ACTH gel — the first question that often comes up is: which one? Two brand-name products currently carry FDA approval in the United States: Acthar Gel, which has been on the market for decades, and Cortrophin Gel, which was relaunched by ANI Pharmaceuticals in 2021. Both contain the same active ingredient. Both treat many of the same serious inflammatory conditions. And neither has a generic version available.

Yet the differences between them — in price, in specific approved indications, and in copay assistance programs — matter enormously for patients navigating a diagnosis of multiple sclerosis, lupus, rheumatoid arthritis, nephrotic syndrome, or other conditions where ACTH therapy may be prescribed.

This guide breaks down what patients and caregivers need to know.

Cortrophin Gel vs. Acthar Gel — Quick Overview

WAC = Wholesale Acquisition Cost. Sources: IBM Micromedex® RED BOOK®; Keenova Therapeutics. Cortrophin Gel Reimbursement & Support. Accessed March 2026. Prices do not reflect actual patient out-of-pocket costs, which vary by insurance coverage and assistance program enrollment.

What is Cortrophin Gel (repository corticotropin)?

Cortrophin Gel is a purified, naturally sourced adrenocorticotropic hormone (ACTH) derived from porcine (pig) pituitary glands. Its generic name is repository corticotropin injection USP. The FDA originally approved it decades ago, and ANI Pharmaceuticals relaunched it in 2021 as a lower-cost alternative to Acthar Gel within the ACTH drug class.

According to Lexi-Drugs (UpToDate), corticotropin belongs to the pharmacologic category of Adrenocorticotropin Stimulating Hormone. It works by stimulating the adrenal cortex to produce and secrete a range of adrenocortical hormones — primarily cortisol — which then produce anti-inflammatory and immunosuppressive effects throughout the body.

An important distinction: Cortrophin Gel is not a biosimilar or a generic, and it is not a synthetic drug. Cortrophin Gel is a naturally derived biological product — a purified extract — which explains why it shares regulatory characteristics with Acthar Gel rather than following the traditional generic drug approval pathway.

Both Cortrophin Gel and Acthar Gel are administered by subcutaneous (under the skin) or intramuscular (into the muscle) injection. Neither can be given intravenously. Both are available only through specialty pharmacies.

Same active ingredient — so what’s actually different?

This is the question most patients and caregivers ask first — and it is a fair one. Cortrophin Gel and Acthar Gel contain the same active ingredient — repository corticotropin injection derived from porcine pituitary tissue. They work identically, stimulating the adrenal glands to produce cortisol, and share the vast majority of their FDA-approved indications.

The key differences are as follows.

Infantile spasms: This is the most clinically significant distinction. According to the Lexi-Drugs monograph, Acthar Gel carries FDA approval for the treatment of infantile spasms in patients under 2 years of age. Cortrophin Gel does not carry this indication. For families of children with infantile spasms, Acthar Gel remains the only FDA-approved ACTH option.

Price: The wholesale acquisition cost (WAC) of Cortrophin Gel is approximately 23% lower than Acthar Gel per mL, based on January 2025 pricing data. Many insurance formularies now prefer Cortrophin Gel because of this price difference — a key reason ANI Pharmaceuticals relaunched the product in 2021.

Copay assistance caps: Cortrophin Gel’s manufacturer copay savings program offers eligible commercially insured patients up to $25,000 in assistance per calendar year, compared to $15,000 per year for Acthar Gel’s commercial program — a $10,000 difference that matters enormously for patients on long-term therapy.

Formulations: As of March 2025, Cortrophin Gel is also available in prefilled syringes in addition to multidose vials — an option that can make home administration more convenient for some patients.

For conditions other than infantile spasms, the clinical profile of both medications is similar. Your prescribing physician and insurance formulary will typically guide which product is prescribed.

How much does Cortrophin Gel cost compared to Acthar Gel?

Both medications are among the most expensive specialty pharmaceuticals in the United States. Understanding the price difference — and what patients actually pay — requires looking at two separate numbers: the list price and the out-of-pocket cost with assistance.

List price (WAC), January 2026:

• Cortrophin Gel: $7,169.80 per mL
• Acthar Gel: $9,332.60 per mL

Manufacturers publish these wholesale acquisition costs before insurance, rebates, or copay assistance apply. According to pricing data cited by the Cortrophin Gel manufacturer’s HCP website (ANI Pharmaceuticals), Cortrophin Gel carries approximately a 23.2% discount relative to Acthar Gel based on the 5-mL vial, per January 2026 WAC data sourced from IBM Micromedex® RED BOOK® and Keenova Therapeutics.

However, very few patients pay list price. What patients actually pay depends on their insurance coverage and whether they are enrolled in available assistance programs.

What commercially insured patients may pay: Eligible commercially insured patients enrolled in the Cortrophin In Your Corner Copay Savings Program may pay as little as $0 per prescription fill, with a maximum savings limit of $25,000 per calendar year. Eligibility requirements apply, and enrollment is required.

What Medicare patients face: Medicare patients cannot use manufacturer copay cards due to federal regulations — the same gap that affects most specialty medications. However, foundation grants, patient assistance programs, and Medicare’s Low-Income Subsidy (Extra Help) program may provide relief. A specialty pharmacy with dedicated patient navigators — like QuickRx — can identify every available option for Medicare patients at no cost.

What uninsured patients face: Without insurance or assistance, the cost of ACTH therapy is prohibitive. Patient assistance programs through ANI Pharmaceuticals and independent foundations exist to address this gap.

The bottom line: the list price of both medications is extremely high, but most patients who work with a specialty pharmacy to access available assistance programs pay significantly less — sometimes nothing.

What conditions does Cortrophin Gel treat?

According to the Lexi-Drugs monograph (UpToDate, last updated April 6, 2026), Cortrophin Gel is FDA-approved for the following conditions in adults:

Multiple sclerosis

Physicians prescribe Cortrophin Gel as an alternative therapy for acute MS exacerbations in adults — specifically when IV corticosteroids cannot be administered or are not tolerated. Per Lexi-Drugs, the recommended dose for this indication is 80 to 120 units per day for 2 to 3 weeks via intramuscular or subcutaneous injection. Treatment guidelines note that high-dose IV or oral methylprednisolone remains the preferred first-line therapy for acute MS exacerbations; corticotropin may be considered when corticosteroids are not an option.

Rheumatic disorders

Rheumatology guidelines generally no longer recommend corticotropin as a primary treatment for these conditions — current ACR guidelines do not include it as standard of care. However, physicians may consider Cortrophin Gel for patients who have failed or cannot tolerate standard therapies.

Collagen diseases

Approved for exacerbations or maintenance therapy in select cases of systemic lupus erythematosus (SLE) and systemic dermatomyositis (polymyositis).

Nephrotic syndrome

Approved to induce diuresis or remission of proteinuria in nephrotic syndrome without uremia — specifically idiopathic nephrotic syndrome or nephrotic syndrome due to lupus erythematosus.

Dermatologic diseases

Approved for severe erythema multiforme, severe psoriasis, Stevens-Johnson syndrome, atopic dermatitis, and serum sickness.

Ophthalmic diseases

Approved for severe acute and chronic allergic and inflammatory conditions involving the eye.

Sarcoidosis

Approved for symptomatic sarcoidosis. Current guidelines suggest corticotropin may be considered for patients in whom glucocorticoids and/or antimetabolites have failed.

What Cortrophin Gel does NOT treat: Unlike Acthar Gel, Cortrophin Gel is not FDA-approved for infantile spasms. Families whose children need ACTH for infantile spasms should speak with their neurologist about Acthar Gel — the only FDA-approved ACTH product for that indication.

Always consult your prescribing physician regarding the appropriateness of Cortrophin Gel for your specific diagnosis and medical history.

What are the side effects of Cortrophin Gel?

Cortrophin Gel’s side effects are related to its mechanism of stimulating adrenal cortisol production — similar to the side effect profile seen with systemic corticosteroid use. According to the Lexi-Drugs monograph, reported adverse reactions include the following:

Occurring in more than 10% of patients (from infantile spasms clinical data)

• Hypertension (11%)
• Infection (20%)
• Seizure (12%)

Occurring in 1% to 10% of patients

• Cardiac abnormality, including cardiac hypertrophy (3%)
• Cushing syndrome (3%)
• Weight gain (1%)
• Decreased appetite, diarrhea, vomiting (3% each)
• Candidiasis (≥2%)
• Irritability (7%)
• Otitis media (≥2%)
• Nasal congestion (1%), pneumonia (≥2%), upper respiratory tract infection (≥2%)
• Fever (5%)

Common side effects applicable to all corticotropin use (frequency not defined)

• Acne vulgaris
• Fluid retention including peripheral swelling
• Increased blood glucose
• Osteoporosis and pathological fracture with long-term use
• Psychiatric disturbances: depression, euphoria, insomnia, mood swings, personality changes, irritability
• Hypokalemic alkalosis
• Sodium retention
• Wound healing impairment
• Ophthalmic: glaucoma, increased intraocular pressure, subcapsular posterior cataract
• Gastrointestinal: nausea, pancreatitis, peptic ulcer with hemorrhage
• Injection site reactions

Important note on stopping treatment: According to Lexi-Drugs, abrupt withdrawal of Cortrophin Gel may lead to adrenal insufficiency or recurrence of symptoms, particularly after prolonged use. Tapering the dose gradually under physician supervision is essential before discontinuing therapy.

Who should not take Cortrophin Gel?

The Lexi-Drugs monograph identifies the following contraindications for Cortrophin Gel:

• Hypersensitivity to proteins of porcine (pig) origin — Cortrophin Gel is derived from porcine pituitary tissue
• Scleroderma
• Osteoporosis
• Systemic fungal infections
• Ocular herpes simplex
• Recent surgery
• History of or active peptic ulcer disease
• Congestive heart failure
• Uncontrolled hypertension
• Primary adrenocortical insufficiency or adrenocortical hyperfunction

Cortrophin Gel must never be administered intravenously. It is for subcutaneous or intramuscular injection only.

Patients should also use Cortrophin Gel with caution if they have diabetes mellitus, cardiovascular disease with associated hypertension, a history of psychiatric disturbances, tuberculosis or latent TB, or any conditions requiring immunosuppression monitoring. Drug interactions also exist with live vaccines, NSAIDs, antidiabetic agents, diuretics, and other immunosuppressants — always inform your healthcare provider and pharmacist of all medications you are taking.

This is not a complete list of contraindications or precautions. Always review your full medical history and current medication list with your prescribing physician before starting Cortrophin Gel.

References

1. Corticotropin (Lexi-Drugs). UpToDate® Lexidrug™. Wolters Kluwer Health. Last Updated April 6, 2026.
2. Cortrophin Gel (repository corticotropin injection USP) [prescribing information]. Baudette, MN: ANI Pharmaceuticals Inc; August 2025.
3. ANI Pharmaceuticals. Cortrophin Gel Reimbursement & Support. WAC pricing data, January 2026. Sources: IBM Micromedex® RED BOOK® and Keenova Therapeutics. cortrophinhcp.com
4. Keenova Therapeutics. Acthar Gel Product Pricing. Accessed March 2026. keenova.com
5. US Food and Drug Administration. Cortrophin Gel prescribing information. FDA.gov