Trends and Characteristics of US Medicare Spending on Repository Corticotropin

Hartung, Daniel; Johnston, Kirbee; Leuven, Shelby Van; Deodhar, Atul; Cohen, David; Bourdette, Dennis

doi:10.1001/jamainternmed.2017.3631

Cited by 21 publications

(22 citation statements)

References 2 publications

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“…From 2011 to 2015, spending on corticotropin in the US Medicare program increased 10-fold, totaling more than $1 billion during this period. 27 In 2015 alone, Medicare spent more than $500 million on corticotropin, making it one of the most expensive drugs paid for by the program. 28 The continued growth in corticotropin use is peculiar given its very high cost, widespread negative media coverage, and notable lack of evidence supporting its use over lowercost synthetic corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

Industry Payments to Physician Specialists Who Prescribe Repository Corticotropin

et al. 2018

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Key Points Question What is the association of industry payments to physicians and prescriptions for repository corticotropin (H. P. Acthar Gel; Mallinckrodt Pharmaceuticals)? Findings In this cross-sectional study of 235 specialist physicians who frequently prescribe corticotropin to Medicare beneficiaries, 207 (88%) received a monetary payment from the drug’s maker, with more than 20% of frequent prescribers receiving more than $10 000. There was a significant association between higher dollar amounts paid to these prescribers and greater Medicare spending on their corticotropin prescriptions. Meaning Financial conflicts of interest among physicians may be driving corticotropin expenditures for the Medicare program.

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Section: Introductionmentioning

confidence: 99%

Industry Payments to Physician Specialists Who Prescribe Repository Corticotropin

et al. 2018

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“…With regard to SRNS, one study with 24 FSGS patients reported complete or partial remission in 29% (7/24) after initiation of ACTH gel treatment, suggesting its possibility as a treatment option [ 77 ]. However, the high expense of ACTH, the relative lack of evidence [ 133 ] and recent reports on its prescription having been influenced by financial conflict of interest [ 134 , 135 ] should prevent hasty recommendations on this drug being made.…”

Section: Non-immunologic Therapiesmentioning

confidence: 99%

Current understandings in treating children with steroid-resistant nephrotic syndrome

et al. 2020

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Steroid-resistant nephrotic syndrome (SRNS) remains a challenge for paediatric nephrologists. SRNS is viewed as a heterogeneous disease entity including immune-based and monogenic aetiologies. Because SRNS is rare, treatment strategies are individualized and vary among centres of expertise. Calcineurin inhibitors (CNI) have been effectively used to induce remission in patients with immune-based SRNS; however, there is still no consensus on treating children who become either CNI-dependent or CNI-resistant. Rituximab is a steroid-sparing agent for patients with steroid-sensitive nephrotic syndrome, but its efficacy in SRNS is controversial. Recently, several novel monoclonal antibodies are emerging as treatment option, but their efficacy remains to be seen. Non-immune therapies, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, have been proven efficacious in children with SRNS and are recommended as adjuvant agents. This review summarizes and discusses our current understandings in treating children with idiopathic SRNS.

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“…28 For example, total Medicare spending on repository corticotropin, a pediatric antiseizure medication with limited effectiveness over less costly alternative medications in adults, increased nearly 13-fold, from $49.5 million in 2011 to $636 million in 2016, with the cost per claim increasing from $33,621 to $49,442 during that period. [32][33][34][35][36] In contrast to these U.S. circumstances, most other countries use price regulations (e.g., reference pricing, health technology assessment) to control drug costs. 37 Additional manufacturer practices increase U.S. payer outlays.…”

Section: ■■ Foundation Of Drug Benefit Management In Early Pbm Business Modelsmentioning

confidence: 99%

Changes in PBM Business Practices in 2019: True Innovation or More of the Same?

Motheral¹,

Fairman²

2020

JMCP

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In 2019, pharmacy benefit managers (PBMs) responded to intense public criticism with business model changes described as movements toward full transparency and innovation to reduce costs for benefit plan sponsors. We critically analyze these changes in light of key challenges in specialty drug management: pharmaceutical manufacturer practices (price increases driven by coverage mandates and lack of price control, intensive and sometimes misleading advertising, patent extensions), FDA changes (increased reliance on manufacturer funding, weakened evidentiary base for drug approvals), and provider prescribing patterns (lag from evidence to routine practice, manufacturer influences on the knowledge base, direct manufacturer payments to frequent prescribers).The persistence of controversial PBM practices suggests that business model changes were mostly cosmetic, without altering key marketplace dysfunctions. Examples include "spread" pricing, in which PBMs pay pharmacies less than employer-paid amounts; rebate-influenced formulary development; and shifting of prescription volume to PBM-owned pharmacies. Spread in Medicaid was estimated at $224.8 million in Ohio and $123.5 million in Kentucky in 1-year periods and is the subject of an ongoing federal investigation. Rebate influence on formulary development is suggested by slow biosimilar adoption and a study documenting little association between brand exclusions and clinical or cost-effectiveness. Even in 100% passthrough arrangements, the price differential between rebated products and lower-cost alternatives may far exceed revenues returned to the payer. Shifting of business to PBM-owned pharmacies was identified in Florida managed Medicaid in 2018, where the state's 5 largest specialty pharmacies, all owned by managed care organizations or PBMs, collected 28% of prescription drug profit despite dispensing only 0.4% of claims. Finally, contract provisions and terms typically limit the ability of plan sponsors to monitor PBM performance. These include "offsetting," changes in definitions (e.g., "single-source generic") during the contract term, restrictions on audit rights, and exclusion of some pharmaceutical manufacturer revenues from "100%" passthroughs. We conclude that ostensibly positive changes in PBM practices have been offset by undisclosed business arrangements, shifts to alternative revenue sources, and opaque contractual terms. Establishing and maintaining a sustainable benefit will require fundamental alterations to this dysfunctional market

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Trends and Characteristics of US Medicare Spending on Repository Corticotropin

Abstract: Ms Cole had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 21 publications

References 2 publications

Industry Payments to Physician Specialists Who Prescribe Repository Corticotropin

Industry Payments to Physician Specialists Who Prescribe Repository Corticotropin

Current understandings in treating children with steroid-resistant nephrotic syndrome

Changes in PBM Business Practices in 2019: True Innovation or More of the Same?

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