In 2013 and 2014, Medicare spent at least $650 million on a single multiple sclerosis drug, H.P. Acthar Gel. It was prescribed by less than one percent of doctors, with questionable results.
Two Oregon Health and Science University researchers investigated the amount Medicare spent on H.P. Acthar Gel. Notably, Acthar used to sell for $40 per vial. More recently, the price increased from $748 in 2001 to a whopping $34,034 in 2014. This means it costs more than $100,000 to treat a single patient with Acthar. But treating patients with prednisone or other similarly-effective steroids would cost just a few hundred dollars.
“I was shocked at how much money Medicare was paying for prescriptions of Acthar,” said Dr. Dennis Bourdette. He and Daniel Hartung, Pharm.D., had previously written an article, “The cost of multiple sclerosis drugs in the U.S. and the pharmaceutical industry: Too big to fail?” for the journal Neurology.
Bourdette and Hartung, along with Kirbee Johnston, M.P.H., of OSU, and Shelby Van Leuven of OHSU, examined publicly accessible data from Medicare Part D. They discovered that less than 1 percent of physicians prescribed Acthar in 2013 and 2014 at a cost of more than $650 million to Medicare. Importantly, 40 percent of the cost to Medicare could be traced to a very small number of specialists in neurology, nephrology and rheumatology — a total of 274 physicians — who prescribed Acthar 11 or more times in 2013 and 2014.
“Because of the tremendous cost, you really should have evidence that it’s superior and beneficial compared to much cheaper forms of generic steroids, like prednisone,” Hartung said.
However, the researchers noted there is no evidence that there are any significant clinical differences between Acthar and very low-cost steroids for treating attacks of multiple sclerosis or for any other autoimmune disease.
Acthar was developed in the 1950s. In 2001, it was sold to Questcor Pharmaceuticals, and thereafter sold to Mallinckrodt Pharmaceuticals. The drug stimulates the adrenal glands to produce natural steroids, with similar effects as prednisone and other synthetic anti-inflammatory steroids. Mallinckrodt recently agreed to pay $100 million to settle an antitrust lawsuit concerning Acthar.
Hartung noted the lack of evidence Acthar is superior to much cheaper steroids. “We question why a small number of physicians are prescribing this extremely expensive drug when there are much cheaper alternatives.” A 2015 pilot study of sarcoidosis patients showed 37% had to discontinue Acthar gel therapy due to cost, death, and drug toxicity.