Repository Corticotropin Injection (Acthar Gel / Porcine ACTH)

Natural extract from porcine (pig) pituitary glands containing adrenocorticotropin (ACTH) and other pituitary peptides. Used for infantile spasms (West syndrome), multiple sclerosis relapses, and nephrotic syndrome. Mallinckrodt is the sole manufacturer. List price reached ~$38,000/5mL vial by 2019 — one of the most expensive drugs in the US — up from $40/vial in 2001. Manufactured at Haverhill, MA and St. Louis, MO. FTC brought antitrust action alleging Mallinckrodt paid off competitors to prevent ACTH alternatives from entering the market.